HomeMy WebLinkAboutBuilding Permit Application SUPPLEMENTAL CONSTRUCTION„LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: Ft.Pierce State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: IIENot Applicable
Name: Name:
Address: P•O.Box 12867 Address:
City: City:
Zip: Phone: Zip: Phone:
OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no representation that is granting a permit will authorize thepermit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules,bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home.Owners Association•and review your deed,for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will,in all respects,perform the work
in accordance with the approved plans,the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review:room additions,
accessory structures,swimming pools,fences,walls,signs,screen rooms and accessory uses to other non-residential use
WARN TO O R: o failure to Record a Notice of Comm emen y result in y r paying twice for
imp vemen our propee y. A Notice of Commenceme must r rded and o ted on the jobsite
b ore the ' s i pectin If ou intend to obtain financi , cons I nder r a torney before
ommen ' o k or rdi our Notice of Commen ement.
`sir,of, a ssee/Contractor-as,Age6 for_C+wneF� _ —_ tl o Contract �• icense.Holders
STATE OF FLORID �r� STATE OF FLORIDA
COUNTY OF � 1 / COUNTY•OF
The oing instrijiment was acknowledg efore me The rg Ing instru ent was acknowledg before me
thi d of 20 by this l/ day of 20+_ by
V 11114
Name of per n makin statement Name of per_gn making statement
Personally Known OR Produced Identification Personally Known(/ OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Signature of Notary Public-State of Florida (Signature of Notary Public-State of Florida)
r, r','' �INDADARDEN
Commission No. ��;; blit—state of Florida Commission No. iry11"':( a I PELINDA DARDEN
.; ; Commission#GG 169025 q. �4q=Notary Public—State of Florid
,tt w My Comm.Expires Dec 18,2021 a Commission#GG 16
►� 9025
`•2air�.. ndedthrouyhNatonelNotary AM
oY':My Comm.Expires Dec 18,202
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ' Permit Number:
- -� REC . vro
m
- Building Permit Applicatio JUL 0 3 2019
Planning and Development Services ST. Lucie County, Permitting
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 /
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential V
PERMIT APPLICATION FOR: Roof
PROPOSED IMPROVEMENT LOCATION:
Address: 71202 PPn.n CY a0 Ja kQ c?
Legal Description: 1.:(a woc 4. -1 It/1* LP [3k)gipL- L4M-2-
Property Tax ID#: L9Q(_Q jl0-(M Lot No. 2
Site Plan Name. N/A Block No. C04
Project Name:, N/A'
Setbacks Front N/A Back: N/A Right Side: N/A Left Side: N/A
DETAILED DESCRIPTION 1NO
OFrORK
a , e
W 2 \rv%q svnlke.
Y<C'n _kk -k t> C X'M- r cvr�-- C.C4' . v'S-(Sfi ot, 50 V✓\a-'k 0.ra nsNo kk
5-V vyv__�Cj Y-C)o{Z Y.
Ec:ONSfRUCTIO';
N"INFORMA ON: =
Additionalworkto . e performed_ under t is permit-check a app y:
❑HVAC Gas Tank Gas Piping. _Shutters El Windows/Doors
Electric 0 Plumbing Sprinklers Generator 21 Roof 3 1'L Roof pitch
Total-q^F-GofCarrsti•ffetio'nI- - S . Ft.of First Floor: N/A
Cost of Construction:$ ` 500 ,�('� Utilities: Sewer Septic Building Height: N/A
OWNER/LESSEE: CONTRACTOR:
"Name:Tral'ls i U ( WS ;Name: Christopher Collihs
Address: _7SA2 P 'Collin's" Roofing;Inc.
City: - �*L v C'P- State: Address: P-O. Box 12867'
-Zi"p'C6de:. �� �, " Fax: N/A City: Ft.Pierce State: FL
Phone No. N/A Zip Code: 34979 Fax: 772-489-6505
E-Mail: N/A Phone No. 772-201-13521
Fill in fee simple Title Holder on'next page(if different E-Mail: collinsroofinginc@gmail.com
from the Owner listed above) State or County License: CCC-058011
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.