HomeMy WebLinkAboutAIl APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTEDAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
�o C�CLL
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: Roof Replacement
PROPOSED. IMPROVEMENT LOCATION:
Address: 11570 Palomino DRPorl St Lucie. FL 34987
Property Tax ID #: 3309-605-0038-000-9 — _ Lot No.35
Site Plmi Name: Block No, A
Project Name
DETAILED DESCRIPTION OF WORK: -�
/7-
New Electrical Meter Second Electrical Meter
L CONSTRUCTION INFORMATION:
Additional work to be performed under this permit — check all that apply:
_Mechanical _ Gas Tank —Gas Piping , Shutters Windows/Doors Pond
I — Electric __ Plumbing _ Sprinklers _ Generator � Roof ��%2 Pitch
Total Sy. Ft of Construction: 4600 5q. Ft. of First Floor: — �—
Cost of Construction: $ 18.400.00 Utilities: _-Sewer _Septic
OWNER/LESSEE CONTRACTOR:
Name
Address: 1
City: State:
Zip Code: �cl c2 Fax:
Phone No. — a. 1]11 }{- te.?-L - y
E-Mail: r4,,%-34ln0t)A—) link
Fill in fee simole Title Holder on next page ( if different
from the Owner listed above)
Building Height:
Name: Derion Blidgen
Company: De'Rion Group LLC
Address:4625 45TH Street
City: Vero Beach
Zip Code: 32967 Fax: _
Phone N0772-532-7663
E-Mail deriongroup@gmail.com
State or County License CCC1 330567
-�•�� u. vnmuunion is zSuu 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.
State: FL
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
MORTGAGE COMPANY:
Name:
_ Not Applicable
DESIGNER/ENGINEER: Not Applicable
Name.
Address:
Address:
City:
Zip: Phone
FEE SIMPLE TITLE HOLDER:
Name:
State:
Not Applicable
City:
Zip: Phone:
State:
BONDING COMPANY:
Name:
Not Applicable
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 ruies, bylaws or and covenants titat 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 -intend to obtain financing, consult
with lender or an attorney ht-fnrp rnmmanrinv wnrle nr turn 4;nn %, M di . f
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature r/License Holder
STATE OF FLORIDA
=FLO�,IDA
STATE OCOUNTY
OF T.�«�, 'ytl �'
COUNTY OFcl
Sworn to {or affirmed) and subscribed before me of
P �6J cal Pre n e or Online Notarization
�
Sw rn to (or affirmed) and subscribed before me of
� P y�cal Prese ce or Online Notarization
this day of 2021 by
this day of �VLI,-, 2021 by
• fit:
Name of person making statement. �€Name
F
of person making state ent.
Personally Known OR ProducedPersonally
i
Known OR Produced Identification
\Int1iicat�Pn\
Type of IdentificaiionType
of Identification
Produced il3 �Produce
= kotaryp1171l SgES { Cn blir - Sta
(S ary Public- State of Florida I $ o
(Signature of Notary Public- Sta da) °mm.p�r cGI11�61
A k 107 r o
Commission No. �DOt� (Seal)
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ommissionNo. %12-13��— (seal) y1jp°�ya
I
REVIEWS FRONT ZONING SUPERVISOR
PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW
REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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