HomeMy WebLinkAboutbuilding permit application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fart 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:
Address: 00
Legal Description: ri V o
� a�
Property Tax ID#: 4 00 y" —y Lot No.�
Site Plan Name: Block No.
Project Name:
Setbacks front Back: Right Side: Left Side:
[DETAILED DESCRIPTION OF WORK:
� r d eXis 1n�
and tinder- t♦c����b ,
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit—cle, all apply:
❑HVAC Gas Tank Ej Gas Piping _Shutters ❑.Windows/Doors
❑Electric Plumbing Sprinklers Generator ® Roof S d Roof pitch
Total Sq. Ft of Construction:�� S Ft.of First Floor:
Cost of Construction:$ a2 Q4 4M Utilities: Sewer 0 Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name rr WnV4,c 42,1,nIr7 Name: �
Address: /-Z.ol-) _ ,` rJrsn,! 6/�4 Company: TREASURE COAST ROOFI G
City:_ State:Fe Address: 181/6 5W BILTMORE STREET
Zip Code: ?e/P�z Fax: City: Off " State:FL
Phone No. 70 9 Zip Code: 34984 Fax: 772-343-8358
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 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 SILTMORE 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.
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 Horne 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 recording our Notice of Commencement.
Signature of wner/Less on a r as Agent for Owner Signatu o Contrac r is s older
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF ST LCUIE COUNTY OF-LUCIE
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this JO day of /1/Ov 20 AO by this It day of lVay ,200o by
BRIAN J MALONEY BRIAN J MALONEY N
Name of person making statement Name of person making statement c
Personally Known x OR Produced Identification Personally Known x OR Produced Identifi tion o o
Type of identification Type of Identification o
Produced Produced V m
< CnXIE
� �W
5i nature of Notary Public-State of Florl(Signature of Notary Public-State of Florida) g co E
Commission No. 75/494 (Seal) Commission No. cC7 1(1-)p� (Seal Z v U
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REVIEWS on CRVZJbR PLANS VEGETATION SEA TURTLE GROVE
OU Mhon ° REVIEW REVIEW REVIEW VIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17