HomeMy WebLinkAboutLoparco Reroof ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 10-Z6-ZU 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: "T �1lY�G I
Address:
Legal Description:
Property Tax tD ri: 410-S03-02.77 -&20 -G
Site Plan Name:
Project Name: CN�&p cc
Setbacks Front Back: Right Side: Left Side:
Lot No.
Block No. S
_Mechanical _ Gas Tank —Gas Piping _ Shutters Windows/Doors
_Electric _Plumbing _Sprinklers _Generator Toof 571h lZPitch
Total Sq. Ft of Construction:
Cost of Construction: $ i� PQQ, oo
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic
Building Height: In (
OW NER/LMEE.
CONTRACTOR:
NamJ�td2*&SS,0, L1rCO
Name: C
Address: SNJAuro 1A11%a--
Company:
City: ��fwffl ei State-R,
Zip Code, at"Z� Fax:
Phone No. 77Z" (Me -LA b 40
Address: 9-1
City. State:
zip Code: 3ka9Fax-:nZ-
Phone No 7 - 61S
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail
Via 0.S +�sIA
P�t
State or C unty License 0lt 7Z I A
C.C1— - --
If value of construction is 2500 or more, a -RECORDED Notice of
isregwrea.
SUPPLIMMAL. Ct3NS' IXnON;UEKL W iNFC)W01014:
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:
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
rnmrnpnrina wnrk nr rprnrdine vour Notice of Commencement.
Signa re of Owner/ Lessee/Contractor as Agent for Owner
SignatukKof Contractor/License Holder
STATE OF FLORIDA („�FLORIDA
COUNTY OF
COUNTY OF —
The The f ing instrum was acknowledged before me
Q�
The for ling instrume t as howled ed before me
day Q� 2�Q by
this day of 2 by
I.�_e u1r� .arf�-e ►
this of
l�aM[to _ Lars-�n1
(Name of rson acknowledgin )
(Name of son acknowledging)
(Signatu f Notary Public- State of Florida)
(Sig of N r Public- State of Florida
Personal y Known OR Produced Identification
Personally Known OR Produced Identification
Type of identification
pe of Identification
Produced """°°''. JAIMBdAfI2
oduced
c +P& JAIME ORTIZ
22 0 ,a�f'aq� Public - State of Flori
mmission N �'%h� <(94misslon
:.. .; Notary PybllE = 4fdfe of Florin
`y COmITIS41Efl p �G 22ga4a
Commission No. ..._!` (8R31�fnm, Ikil§ifPs Jmr 13. 202I
p GG Z28444
Bondedthr0*NARinalNotaryAss
n:` My Comm. Expires Jun 13, 20
Bonded through National Notary As
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
I DATE
• RECEIVED
DATE
COMPLETED
Rev.7J),014