HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number
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9 2019
BuildingPermit A lic
Planning and Development Services Department
Building and Code Regulation Division Count2300 Virginia Avenue,Fort Pierce FL 34982 y, FL
Phone: (772)462-1553 Fax: (772)462-1578 Commercial R
PERMITTYPE: .
PROPOSED IMPROVEMENT LOCATION,
Address: Soo u/- 4--f— 4ttr 3
Property Tax ID#: ' !lo SU3 OQgO 0CXD- 3 Lot No.
Site Plan Name: Block No.
Project Name:
,DETAILED DESCRIPTION OF WORK:
LJ U
CONSTRUCTION'INFORMATION!
Additional work to be performed under this permit–check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters Windows/Do rs
_Electric _Plumbing _Sprinklers _Generator Roof itch
Total Sq. Ft of Construction: �Q7 Sq. Ft.of First Floor:
Cost of Construction:$ Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name -H#&- ry 0r) Name:Roland Wiley
Address: v Company:Shoreline Roofing
City: `t�j 42'prL, State: I—'I Address:1973 SW Glendale St
Zip Code: Fax: City: Port St Lucie State:FI
Phone No. Zip Code: 34987 Fax:
E-Mail: Phone No 772-260-9565
Fill in fee simple Title Holder on next page(if different E-Mail Shorelineroofing@yahoo.com
from the Owner listed above) State or County License CCC1331170
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
If value of HVAC is$7,500 or more,a RECORDED Notice of Commencement is required.
SUPPLE:MENTALCgNSTRUGTLON LIfN LAW INFORMATION
.; �.
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLEHOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: 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 the permit 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 another non-residential use
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH Y UR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT:'
V�
Signature of Owner/Lesse ontra Ent for Owner Signature of Contractor/License Hol er
STATE OF FLORIDA - STATE OF FLO `
COUNTY OF COUNTY OF
The f going instru Int was acknowledggo,before me The fo oing instru ent was acknowledged efore me
this day of 201 by this day of 20�by
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Idlic k Type of[den +#iea i n j
Produced Produced ' J
az�
(Signature of Nota �ublic-State of Flor' (Signature of otary P lic-State of Florida B.HUP.IPHREY
Commission No. = Y COMMI GG 300817 Commission BEY B•HUMPt(i3Fe61)
11'*' * EXPIRES:March 6,2023 _s`. "
MY COMMISSION 1P GG 300817
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,OFF•, UV*IEW
nde Nota Publir,Unde tern
REVIEWS ZONING SUPERVISOR PLANS GROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.2/7/19