HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
_ - RECEI EV
Budding Permit Applicati n DEC o 9 ,)o
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 X
PERMIT TYPE:Re-Roof
hPROPOSED°IMPROVEMENT LOCATION
Address: 228 SE Camino St. Port St Lucie, Fl 34952
Property Tax ID#: 3419-515-0227-000-3 Lot N0.38
Site Plan Name: Block No.
Project Name:
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CONSTRUCTION INFORMATION: ti �' } t riti
Additional work to be performed under this permit–check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator v---Roof Pitch
Total Sq. Ft of Construction: x 0 -[� Sq. Ft.of First Floor:
Cost of Construction:$ f a , �J Utilities: —Sewer _Septic Building Height:
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.., / , . CO;NTRACI'OR,+ ;x
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Name Mike Kelly Name:Jeffrey Hampson
Address:228 SE Camino St Company:St. Lucie Roofing
City: Port St Lucie State:_ Address:1919 SW South Macedo Blvd
Zip Code: 34952 Fax: City: Port St Lucie State:FI
Phone No.(772)631-6622 Zip Code: 34984 Fax: (772)207-7354
E-Mail:kellymp3@comcasLnet Phone No(772)3447193
Fill in fee simple Title Holder on next page(if different E-Mail StLucieRoofing@yahoo_com
from the Owner listed above) State or County License CCC1 330816
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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SUPPLEMENT ! a1�ST tUtTION fE Li4W�1[��ORM�,TIO 4 g
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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 Coun 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 SffE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF COUNTYOF FLORIDA 5-r L L Gl _ COUNTY OF STATE OF FLORIDA
The forgoing instrument was acknowledged before me The for oing instrument was acknowledged before me
this day of ,Q Cr— .20-1 by this y day of DTI^ ,20.E by
Name o person making statemen . Name of person making statem nt.
Personally Known_�R Produced Identification Personally Known AOR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Signature of Notary Public-State 6f Florida) (Signature of Notary Public-Stat of Florida)
Commission No. E10F
CONST I{'j PROULX Commission No.
ate of Flom a-Notery Public :oCON CE PROULX
Commission # GG 258328 ;_ 1" tFsState of Florida-Notary Public
Pvnirpn
, ,_ #GO 258a28
September 16, 2022 " My Comr ission Expires
REVIEWS PLANS VEGETATI @pte aMA14G9ME
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