HomeMy WebLinkAboutBuilding Permit Application •a
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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED f�
Date:�n•��1• (� Permit Number: 19 `�C-
RECEIVED
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Building Permit Application OCT 2 3 2019
Planning and Development Services
Building and Code Regulation Division ST. Lucie County, Permitting
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential K X X
PERMIT TYPE:Re-Roof Shingle to: MticLl
P-ROP`OSED I(VI'P,.ROUE'IVIENT LOCATION B"
Address: 17520 Hammock Ln Port St Lucie, FL 34987
Property Tax ID#: 3211-811-0016-010-5 Lot No.
Site Plan Name: Block No.
Project Name: K.\(,l WQV4V 'RRS\MIXE
DES
QETAILED CRIPTION OF WORK
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CONSTRUCTIQN iNnFORMATION
Additional work to be performed under this permit–check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers _Generator ✓Roof T Pitch
Total Sq. Ft of Construction: q3C) Sq. Ft.of First Floor:
Cost of Construction:$ 13�$��1.� Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE ,b CONTRACTOR P }
t �YB
Name Ora W Richmond Jr Name:Juan Martinez
Address:17520 Hammock Ln Company:Total Roofing Systems Specialist
City: Port St Lucie State: F1. Address:3201 SE Dominica Terrace
Zip Code: 34987 Fax:772-872-8033 City: Stuart State:FL
Phone No.772-872-8030 Zip Code: 34997 Fax: 772-872-8033
E-Mail:samira@total roofingsystems.net Phone N0772-872-8030
Fill in fee simple Title Holder on next page(if different E-Mailsamira@totalroofingsystems.net
from the Owner listed above) State or County License ccc1330788
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.
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SUPPLEMENTAL CQNSTRUCTIDN
"Ll ',N LAW INFORMATION
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _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 TOO TAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF ENCEMENT."
Signature of Owner/Lessee/Contractor as Agent for Owner Signatur Contractor/License Hol
STATE OF FLORIDA TE OF FLORIDA ,
COUNTY OF MCkr+1 T( COUNTY OF a.r`I"I
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 2-2— day of Ohafl '20 /y by this ZZ day of 0 C+-00e,1r_ 20J'1 by
Oro- W. 9-Khm0nd J U-0-n mar+)nt
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced identification
Type of Identification Type of Identification
Produced Produced
(Signature of NotWy Public-State of lorida) (Signature of Notary'Public-State d Floridadl Cq )
CeOrD0013
Commission No. 6dcol SGp 5 mission No. ICTORIA JURADO-LAR
v �� A VICTORIA JURADO-L ( Y
Notary Public-State of Flor ea i, ,y `_ Notary Public-State of Flori
Commission#GG 360013 0`3 Commission a GG 360013
arM1 My C mm,Expires Jul 29, 023 ••.•.F,.,..• 3
REVIEWS FRONT ed th o 9:2ssn NS VEGETATION a thr,u h a i t As n.
COUNTER REVIEW E E IEW REVIEW REVIEW REVIEW
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