HomeMy WebLinkAboutBuilding permit appALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
Building Permit Application
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: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: j4a UlZ'L'k AJN cV
AA
Legal Description: qukxvy's Goye. Un+ l
Property Tax ID #: l -f 1 cl - Z)-0 Lot No. _
Site Plan Name: Block No.
Project Name:
Setbacks Front Back:
DETAILED DESCRIPTION OF WORK:
Right Side: Left Side:
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CONSTRUCTION INFORMATION:
itiona wor to e e orme under t ispermit — check all appy:
HVAC Gas Tank Gas Piping _ Shutters F� Windows/Doors
11 Electric Plumbing 1:1Sprinklers Generator Lei Roof Roof pitch
Total Sq. Ft of Construction: 620 S . Ft. of First Floor:
Cost of Construction: $ , 0 60 Utilities: DSewer Septic Building Height:
OWNER/LESSEE:
CONTRACTOR: Of
Name Ath r
Name: [? 16,7e
Address:t/
City: 0 i
Zip Cade: 3t/g y9
Phone No. C�'
1/t •t
State:
Fax:
G.� �S d $
Company: TREASURE COAST ROOFING
Address: 1816 SW BILTMORE STREET
City: 'a el JXI llo:�elk State: FL
Zip Code 349$4 Fax: 772-343-8358
Phone No. 772-370-9770
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E -Mail: TCROOFINGLLC@GMAIL.COM
State or County License: CCC1330653
if value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
Name:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: Not Applicable
Name:
Address: 1818 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
commencine work or recording vour Notice of Commencement.
Rev. 8/2/17
h
Sign to owner/ ssee tractor as Agent for Owner
Signature of C actor/Licen Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF ST LCUIE
COUNTY OF STLUCIE
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this /9 day of A%9 2Q0V by
this _I:f day of 20_,v?oby
BRIAN J MALONEY
BRIAN J MALONEY
Name of person making statement
Name of person making statement
Personally Known X OR Produced Identification
Personally Known x OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature of Notary Public- State of F rida)
(ignature of Notary Public- State of Floc• a }
Commission No. g7Y� (Seal)
Commission No.6' _25�2_(Seal)
�+ ?/t. Notary Publis State f Florida
Victor G Aiterizio
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DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17