HomeMy WebLinkAboutBuilding permit applicationALL 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 _ X
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address:
Legal De<
Property Tax ID #:
Site Plan Name:
Project Name:
Setbacks Front
Oa -- C o o- e W`Kos - Y3 --
Back: Right Side
DETAILED DESCRIPTION OF WORK:
Left Side:
Lot No.
Block No.
eon C4 Q JI l �%f t1r� goo � a • �c1 i �5 � 411 r�2w � � rn ��- al J��b�
CONSTRUCTION INFORMATION:
A itiona wor to e er orme AnCHI t is permit — c ec a app y:
❑_ HVAC Gas Tank Gas Piping _ Shutters ❑Windows/Doors
❑ Electric ❑ Plumbing Sprinklers Generator Ik Roof Roof pitch
Total Sq. Ft of Construction: / '4o S Ft. of First Floor:
Cost of Construction: $ utilities:Sewer O Septic Building Height:
OWNER/LESSEE:
Name GNU
Address: S S r a 1rie, g--
City:i}<QtLt State:AFZ
Zip Code: ,3y98,;� Fax:
Phone No.
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
CONTRACTOR:
Name: i GCS
Company: TREASURE COAST ROOFING
Address: 1816 SW
11 BILTMORE STREET
City: �" t 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 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
commencing work or recordin our Notice of Commencement.
2
Signa ure of Owner/ see/ ontractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF srtculE
The forgoing instrument was acknowledged before me
this day of ', 20 _, by
BRIAN J MALONEY
Name of person making statement
Personally Known x OR Produced Identification
Type of Identification
Produced
_AW (Signature of Notary Public- State of Florida }
Commission No.U-61702 (Seal)—
REVIEWS I FRO
COUr
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17
victor G Alterizio
My Cornission Expires 11,
IINt90m i M0PERV4
Signature of Contractor icen V
der
STATE OF FLORIDA
COUNTY OF sT LUCIE
The forgoing instrument was acknowledged efore me
this day of `� 2 , by
BRIAN J MALONEY
Name of person making statement
Personally Known X OR Produced Identification
Type of Identification
Produced
(Signature of Notary Public -State of lorida )
Commission No.6C 74�(Seal)
VEGJTATI
RE IEW