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HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE IN O MVST BE COMPLETED FOR APPLICATION TO BE ACCEPTED II Date: Permit Number: l� 0LS 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: Roof PROPOSED IMPROVEMENT LOCATION. Address: Z 1i-'kyi IFL 3 q(R s-Z Legal Description: kxkC 85+4- �C5 0 IJE' ®T 6 ql,—Iq0 I � Property Tax ID#: !)14 z(o— 3—©V ® 006 2 Lot No. 9 Lf Site Plan Name: 0"10 Block No. Project Name: Op Setbacks Front Back: Right Side: X Left Side: DETAILED DESCRIPTION OF WORK CONSTRUCTION INFORMATION lAdditional work to be e rformed under this permit—checl all apply: C�HVAC Gas Tank Gas Piping _Shutters ❑Windows/Doors Electric 0 Plumbing Sprinklers Generator Roof [Z Roof pitch Total Sq. Ft of Construction: `) S Cost of Construction:$ . Ft.of First Floor: �S`� Z© �d Utilities:]Sewer Septic Building Height: I 011VN ER/LESSEE CONTRACTOR:, Name +eq2�Qq WQUCQ Name: HWz ct'a ©QE (4_i 4 Address: '19C1 0 kve CctG� Company: ©V_ D City: \otrA SA State: Address: S ie> c� 1�DCi 4 Zip Code: 3L{ �rJ� Fax: State: f=G Phone No. 4 Zip Code:��4 q 5 3 Fax. (� E-Mail: I✓ Phone No. 2 ` Fill in fee simple Title Holder on next page(if different E-Mail: CIO 15e5FQ0C`S i;eZ43 from the Owner listed above) State or County License: C_C�C— �__IB 6 C 2-2-5 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: pplicable Name: Name: Address: Address: City: State: City: State: Zip: Phone Zip: Phone: FEE SIMPLE TITLE HOLDER: of Applicable BONDING COMPANY: Not Applicable Name: 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 commencing work or recording our Notice of Commencement. Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder STATE OF ORI�Dq ��`j e STATE OF FLORID � �C e T COUNTY OF The fo%oing instrument was acknowled ed before me The for oing instru ent as acknowledged before me this Z day of C3 C-A 20 by this day of C: 20-M by Name of person making statement Name of person making statement Personally Known OR Produced Identification Personally Known OR Produced Identification Type of IdentiRcatioll Type of Identification Produced Produc d v C (Signature of Notary Public- tat ��a AM- a 9J� y P 1$ g t� Signa ure of Notary Put lac.Sta o€Elida), ..r� Wu Y�L CGSCR�fa,..+ {Dn.V Commission No. 42S :sk,� e Y CC3�7Mi SlO.d�:F= r171. EXPIRF S December 7,901g PJ I Sion No. "; MY CO( 3�lO F;325171 (407)398.0553 FlundaNutaryServico, om ?oRF EXPIRES December 17,2019 (407)398.0153 FloridallotaryServica.com I REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev.8/2/17 III