HomeMy WebLinkAboutPermit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 3 )3• a ---D Permit Num
Building Permit
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 X
PERMIT APPLICATION FOR: Roof
Address: 13301 NW Maplewood Rd., Palm City, FL 34990
Legal Description: Harbour Ridge -Plat 13- Recreation Area (0.467AC) (OR 923-1524
Property Tax ID #: 4426-815-0003-000-3
Site Plan Name:
Project Name: Buttonbush Pool House
Setbacks
Back:
e �>
Gas Tank
azn/ r4get//
I I
Piping
UElectric Plumbing ❑Sprint
Total Sq. Ft of Construction: �p 17 s r 0
Cost of Construction: $ ffi (a 7 d .
0 L7
Name Buttonbush Village HOA Inc.
Address: 12600 NW Harbour Ridge Blvd,
City: Palm
Left Side:
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MAR I on 20201
,enL
SL
Lot No.
Block No.
Iv
UShutters ❑ Windows/Doors
UGenerator � Roof RE Roof pitch
Sq. Ft. of First Floor: _
Utilities: Sewer Septic
State: FL
Zip Code: 34990 Fax:
Phone No. `777-- q0,Y-5'L11 9
E -Mail• gy. Q..a4tdr2-�"rT��d-�@2,.yf�G, OcZfa
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Name: Juan Martinez
Building Height:
Company: Total Roofing Systems
Address: 340 Pike Rd.
City: West Palm Beach State: FL
Zip Code: 33411 Fax: 561-784-1098
Phone No. 561-784-3444
E -Mail: maria@totalroofingsystems.net
State or County License: CCC1330788
If value of construction is $2500 or more, a RECORDED Notice of Commencement is
SUPPLEMENTAL CONSTRUCTIO(� LIED L,4U� I�IF(7�iMAT10N
� �A � :,i
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City: tate: '1 V
City: State:
Zip: Phone
Zip: Phone:
y
FEE SIMPLE TITLE HOLDER: Not App, licaRe
Name: _
BONDING COMPANY: _Not Applicable
Name:
Address: 34o Pike Rd. I
Address:
City: i
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 ha�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
commencingfwcirVb� recording your Notice of Commencement.
Signa ure d v5ner/ Lessee/Contractor as Agent for Owner
of Contractor/Licens of
=TATE
STATE OF FLORIDA I
COUNTY OF P�1 dl? G G d
F FLORIDA d
COUNTY OF A107
The forgoing instrument was acknowledged before me
this day of l��' 02.�.�1 , 202? by
The fprgoing instrument was acknowledged before me
this day of Hdae , 20_Z47 by
1)q3
-04a` 4977 AIC 2.
Name of perso making statement
Personally Known , OR Produced Identification
Name of perso�'naking statement
Personally Known L/ OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Si nature of NotaryPublic- tate of Florida)
Si ature of Nota y Publi State of Florida I
40� Notary Public State
Commission No, yr/ 0110&2—li
Maria A Molina
. My Commission G
r8 ^w Expires 04/25/2022'yot
oQdr�aissi nNo6472-i� a� Nota(p�t�� State of Florida
Mari oliva
711062 ` � • M9 Commission GG 211062
no Expires 0412512022
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Rev. 8/2/17