HomeMy WebLinkAboutRe-roof Application LabonteAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: (z ' u% 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 V
Address:
Legal Description: i r7lN✓� Z s S L �h+�- ���
Property Tax ID #: Z�Z� —ZZI— GL'2� L —DDD— Lot No.
Site Plan Name: -1 Block No.
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Project Name: ,:� w�.�P
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK: _ ,
CONSTRUCTION INFORMATION:
7@aitional worK to a pe oror—me un er t is permit- c ec a t at app y.
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator .Roof ,IV% 7Pitch
Total Sq. Ft of construction:
Cost of Construction: $ 174f DhD , 00
Sq. Ft. of First Floor:
1
Utilities: —Sewer _Septic Building Height: 1
OWNER/LESSEE:
CONTRACTOR:
Name
Name:
Company:
Address:
Addres : e -
City:,%ft ewicy State-. '�
Zip Code: 3 CL9A Fax:
City: State��
�' ^7 `
Zip Code:3kQ$ Fax7&-3
Phone No. -�
E -Mail:
Phone No "Z
Fill in fee simple Title Holder on next page ( if different
E -Mail Ol riSi� t hei
State or County License 1�
from the Owner listed above)
If value of construction is 25o0 or more, a K[CUKUGU notice or wmmencemerrt is' C4W11 Cw.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
Name:
Not Applicable
MORTGAGE COMPANY:
Name:
–7k— Not Applicable
Address:
COUNTY OF �J L'J"a .
Address:
The for oing instrum t was acknowledged before me
20�1oy
City:
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
Not Applicable
BONDING COMPANY:
Name:
<—Not Applicable
Address:
(Signature R blic- State of Florida)
Address:
Identification
City:
Personally Known OR Produced
City:
Type of Identification
Zip: Phone:
Produced _,. ND`l RELLENER
�Cj'�� -� f ,`F public - State of Florida
Zip: Phone:
COmmissl n o. Commissioh9lS61)6aItt
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 hrestrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions wich 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
commencin work or recordin our Notice of Commencemen
Rev- 7/2014
S ature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OFF LORID
COUNTY OF <-,4-vc� _
COUNTY OF �J L'J"a .
The for oing instrument as acl owledged before me
The for oing instrum t was acknowledged before me
20�1oy
this day of _L. . ar�� 20� by
thisZ dayof
\j�
I � )6 j
lmdel
person acknowledging )
op'o
(Name rson acknowledging)
1124
�,xJ2 0114 A
(Signature of NOilPublic- State of Florida)
(Signature R blic- State of Florida)
L/
Identification
Personally Known OR Produced Identification
Personally Known OR Produced
Type of identification
Type of Identification
Produced :'�✓'"'. ANDY NELLEHER
(`'G9C' L12 I •; Notary Public . State of Florida
000964271
Produced _,. ND`l RELLENER
�Cj'�� -� f ,`F public - State of Florida
Commission No. com�c'g
Feb 6. 2027'
COmmissl n o. Commissioh9lS61)6aItt
... My Comm. Expire,
._. -' My Comm. Expires Feb 6. 2027
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
®REVIEW
REVIEW
i DATE
RECEIVED
DATE
COMPLETED
Rev- 7/2014