HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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11
V Building Permit Application
Planning and Development Services /
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578
PERMIT APPLICATION FOR: Re-roof
PROPOSED IMPROVEMENT LOCATION:
Address: �J`7 b Se—(-mow✓► GUV I-) ' Fort Pierce FL 34982
Property Tax ID#: 9,Lk 2qt'--1071 r Vo57 QC0 Lot No. 12 & 13
Site Plan Name: Block No. 3
Project Name:
DETAILED DESCRIPTION OF WORK:
New Electrical Meter Second Electrical Meter
[CONSTRUCTION INFORMATION:
Additional work to be performed under this permit-check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors _Pond
Electric _Plumbing _Sprinklers _Generator _K Roof Pitch
Total Sq. Ft of Construction: 1,676 Sq. Ft. of First Floor: 1,676
Cost of Construction: $ 11,500 Utilities: X Sewer —Septic Building Height: 1
OWNER/LESSEE: CONTRACTOR:
Name M&tS_)yY_G C l? Q.Gr"�A Name: cti1 CUv?
Address: kcae_L; ,+,A E�O Company: S ►4�v��C� a"1 f- �c��` .
City: Stater Address: 'UL
Zip Code: y3�Ol Fax: City: pb/c( !i C State:
Phone No. 772-462-1553 Zip Code: Fax:
E-Mail: Phone No Sf -79 1 `—c c,z-y
Fill in fee simple Title Holder on next page(if different E-Mail S' •O 0-04 'I CO- :� d�-(rf�L A CCU
from the Owner listed above) State or County License S A7--e- CCC1327753
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
If value of HAVC is$7,500 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: 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 paying twice for
improvements to your property. A Notice of Commencement must be recorded in the public records of St.
Lucie County and posted on the jobsite before the first inspection. If you ' tend to obtain financing, consult
with lender or an attorney before commencing work or reordivig your Notice of Co encement.
Signature of Owner/Lessee/Contractor as Agent for Owner •Si n ture of Contract / icense Holder
STATE OF FLORIDA ST E OF FLORI
COUNTY OF COUNTY OF '::kA i c4T L•kC i C
Sworn (or affirmed)and subscribed before me of Sworryto(or affirmed)and subscribed before me of
Physical Presence or Online Notarization Physical Presence or Online Notarization
this_21z'jE.h day
j of cC�r 2020 by this�`Nd^ay o[ - �y?'f 2020 by
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Name of person making statement. Name of person mak ng statement.
Personally Known . �OR Produced Identification Personally Known ✓st OR Produced Identification
Type of Identification Type of Identification
Produced Produced
n
r; r r
(Stignature of Notary Public-State of Florida ) (Signature of Notary Public-State of Florida )
Commission No. 'rr q ' f State otFlorida Nola pupa;
{ Don1TXE# Commission No. ? � I�fFlorida
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� ` �t� '�' My Comm ssion'GG 280183
.. My Commission GG 280183
Expires 11/28/2022
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTL01'41 VE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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