HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: i t)-�L-19, Permit Number: o- o 03-6
-71
Building Permit Application st�`c9oP lob,
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: Roof
PKOPOSED�IMPROVEMENT LOCATION:
Address: qS
Legal Description: In U " U r1 l w�" &A
Property Tax I D#: 33 y" So= n i 86 — O0 o — Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION;QF,WORK:
C"n 4�5�a11 .w
CON'STRUCTION:INFORMATION:
Additional work toe nertormed under tispermit—check all that appy:
HVAC Gas Tank Gas Piping _Shutters Q Windows/Doors
Electric 0 Plumbing Sprinklers Generator R Roof Roof pitch
Total Sq. Ft of Construction: 140emf se S Ft.of First Floor:
Cost,of Construction:$ 3,5L—Pe2iQQ Utilities: _Sewer Septic Building Height:
OWN ER/LESSEE: CONTRACTOR:
Name Q- ' Name: Q,
Address: oW 1� Company: REASURE COAST ROOFI G
City: Stater, Address: 1816 SW BILTMORE STREET
Zip ode: Fax:Fax: City: U so.. State:FL
Phone No. ,= ala - 5 6 d� Zip Code: 34984 Fax: 772-343-8358
E-Mail: Phone No. 772-370-9770
Fill in fee simple Title Holder on next page(if different E-Mail: TCROOFINGLLC@GMAIL.COM
from the Owner listed above) State or County License: CCC1330653
i
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
II
SU'PPLEMENTALCONSTRUCTION'LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:, II
City: State: City: State:11
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address:1816 SW BILTMORE STREET 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 jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording our Notice of Commencement.
Sig ature of Owner ssee/Co ctor as Agent for Owner Signaturentractoi nse H r
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF STLCUIE COUNTY OF.STLUCIE
The forgoing instrument was acknowledged before me The forgoing instrument s acknowledged before me
this 4 day of .sQ�7'� 20 9 by this, day of „$'L�' ,20 by
BRIAN J MALONEY BRIAN J MALONEY
Name of person making statement Name of per on making statement
Personally Known x -0 OR Produced Identification Personally KnownOR Produced Identification
Type of Identification Type of Identification
Produced Produced
( ' nature of u lic-State.of Florida) (Signa re o ary ublic-Stat Florida)
Commission No.A�;3,? rSS"R (Seal) Commission No. C-261 U"S (Seal)
REVIEWS FRONT Z SUPERVISOR PLANS VEGETATION \� 1 { iiia MANGROVE
COUNTER \i� {EWAq ��i/,3EVIEW REVIEW 'REVIEW �� kRj. iii REVIEW
DATE
RECEIVED NOT, 9
DATE c� �': — •.�
COMPLETED �