HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
s
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:
`-f Address: 91 l 1 nf- Y J 1
Legal Description: r1 )-a n t V4? _ Lis a T-f s V
Property Tax ID#:, �/U d - fc.�� U O Lot No. clav
Site Plan Name: Block No. DZ
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
e�rC3 6;-r ek fv� %�C f d d o d 1r'f� �/ f U r�c� ads`a
CONSTRUCTION INFORMATION:
Additional work to e Der formed under t is -checkpermit a apply:
❑HVAC E] Gas Tank Gas Piping Shutters Windows/Doors
Electric ❑ Plumbing Sprinklers Generator ® Roof Roof pitch
Total Sq. Ft of Construction: c//6/ S Ft. of First Floor:
Cost of Construction:$ �Q 000 Utilities:[]Sewer Septic Building Height:
OWNER/LESSEE: CONTRACT R:
Name Pe le'- .cz Name: O Y a,, a v /7-Et
Address: Company: TREASURE COAST ROOFING
City: To6 State: L Address- 11816 SW BILTMORE STREET
Zip Code: 3el d` Fax: City: _5 UG G State FL
Phone No. j6 ' Zip Code: 34984 Fax: 772-343-835
E-Mail: Phone No. 772-370-9770
Fill in fee simple Title Holder on next page (if different E-Mail: TCROOFINGLLC@GMAIL.COM
from the Owner listed above) 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 Appli able
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: 1816SW BILTMORESTRLLT 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 j bsite
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.
Signature of Owner/Lessee/C actor as Agent for Owner Signature of C tractor/Li se H
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OFST LCUIE COUNTY OF ST LUCIE
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before rre
this j2D day of S Z0,2D by this day of 2D�by
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 Identificatio
Type of Identification Type of Identification
Produced Produced
'��Z _e
(Signature of Notary Public- tate of Florida) (Signature of Notary Public-State of Aorida J
Commission No. tr7ypa (Seal)_ No. .27 2 QZ (Seal)
Victor G Alte izio
Nota Public,St at of Florida ~ .
My ommission Expi es 11/05/2022 d274292
REVIEWS FRONT ZONI SCE ppRL �ISO� 0 PJ*Ag EGE .ATION SEA TURTLE MA
COUNTER REVIEW— REVIEW R
DATE
RECEIVED
DATE Victor Alter
COMPLETED NotaryPublic.
Rev. 8/2/17 MY Commission Expire
Commission No. G