HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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Kuhn : 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
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RMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of fine
OPOSED IMPROVEMENT LOCATION: t�
Address: 114 w o k
Legal Description: + Q'
Property Tax ID#: � �� "" .7 ��i ` �� ddd '� Lot No.� _
Site Plan Name: Block.No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Q,xi,5 Y1,5 c0-D,( arn � in��all ne
CONSTRUCTION INFORMATION
Aclififiona wor to eler orme un 121 t {s P=:� It, y:
❑HVAC Ll Gas Tank [:]Gas Piping Shutters Vtlrndows/Dflcr s
Electric 0 Plumbing OSprinklers El Generator Roof Roof pitch
Total Sq. Ft of Construction: 0' SQ. Ft.of First Floor:
Cost of Construction: 31S. 0 Utilities: Sewer 0 Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name I A name: h�
Company: T ASURE COAST ROOFAddress: C
I G
to
City: State: } Address: 1816 SW BILTMORE STREET
Zip Code: 319_/ r3� Fax: City: &-e State:FL
Phone No. 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 4
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 Zio: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: _Not Applicable
Name' NamP-
Address. 1816 SW BILTMORF STREET Address:
City: City.
Zip: Phone: Zip: Phone:
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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 Rome Owners.Association miles, byla+nrs 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 resat 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
commending work or recording our Notice of Commencement.
Signature of Owner/Le se Counr r as Agent for Owner I Signat re Contra rJ se Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF STLCUtE COUNTY OFSTWCO
The forgoing instrument was acknowledged before me The forgoing instrumen was acknowledged before me
this day of 20X by this_;XJ d day of go G by
R!AN J MALONEY E!9[AN J WLI ONLY
r Marne of person making Mtement
Name of person makir;g statement l� g
rsonally Known x OR Produced Identification Personally Known x OR Produced ldenti#ic Zion
U LL pe of Identification Type of identification
moduced Produced
U
n7-
oa . o0
5 . ignature of Notary Public-State of Florida (Signat re of Notary Public-State lorida) m �
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0 mmission No. (sG 02;?C143,4 (Seal) Commissi.o.n No. 7Ya'9d (Seal) 6 9°
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EVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MA G ��
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW RE Ifs a
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DATE N
RECEIVED —
DATE
COMPLETED
Rev. 8/2/17 r