HomeMy WebLinkAboutPERMIT 121 QUEEN ANN CTALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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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:
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Legal Description: riS Gove if+1F G+� a 0
Property Tax ID #: I V/y -7 O /- 0CL83- %;)�0 o - 9 Lot No.
Site Plan Name: Block No. _a�7
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
1 e,G ./ o 2 X + �� ins f-0 (J Ct l C4 iA 51011 r-cw ins � 5 , un Ar /ayi
<2 -%c+ F/ A4.
CONSTRUCTION INFORMATION:
Additional work to Be er rmedi un er
❑HVAC Gas Tank
11 Electric ❑_ Plumbing
Total Sr,. Ft of Construction: ,39�6
Cost of Construction: $
OWNERAESSEE:
Name
1'% Oda
t �s permit — check all apply:
Gas Piping _ Shutters Q Windows/Door
Sprinklers Generator Roof Roof pitch
p —
e
S Ft. of First Floor:
Utilities 'n Sewer 0Septic
Address: °� 4.� :6 40-/
City: — 6r � -t State: fG
Zip Code: f c/ Fax:
Phone No.
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
CONTRACTOR:
Building Height:
Name:
Company: TREASURE COAST ROOFING
Address: 1816 SW—BIILTMORE STREET
City: ,,r94 5� L°J`G _ State: FL
Zip Code: 34984 Fax: 772-343-8358
Phone No. 772-370-9770
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 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: 1816 SwBILTMORE 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.
.1
Signature of Owner/ ee/Co ctor as Agent for Owner Signature of C ractor ense o r
STATE OF FLORIDA
COUNTY OF ST LCUIE
The forgoing instrument was acknowledged before me
this__ day of 20.2D by
BRIAN J MALONEY
Name of person making statement
Personally Known x OR Produced Identification
Type of identification
Produced
STATE OF FLORIDA
COUNTY OF STLUCIE
The for oing instrument was acknowledged before me
this r day of 20_.0 by
BRIAN J MALONEY
Name of person making statement
Personally Known X OR Produced Identification
Type of identification
Produced
(Signature of Notary Publi S t of iiri;. I • ature of Not a
Commission No Z (Seal Zia fission No �7�-2�Z'" (Seal} >
N.ctary call ,t�tr of Florida
My Commission? Expires 11/0 2022
Commission No. GG 274292
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGET S A TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17
Victor G Ait rizio �N
r J
My commission Expires 11/05/2022
commission No. GG 274292