HomeMy WebLinkAboutBuilding Permit Application f
ALL APPLICABL INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �
Date. �� '7 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
PERMIT APPLICATION FOR: Roof 177-11
PROPOSED IMPROVEMENT LOCATION
Address: e o S� Oc\vwe_ C \'z_Gi' Volt--\ S 1.00'e- 5 �
Legal Description: uc� S�� L'S \�k�1 �Q� ®F ZOO Ca Qa �.
Property Tax ID#: to` _+03 — Co 1(o— co® - Lot No.
Site Plan Name: Block No.
Project Name: owe-
Setbacks Front Back: 4, Right Side: P Left Side:
DETAILED DESCRIPTION OF WORK
'Qek-kWe E'4�� tOl V00'F
\Os`t�"LL V®®f 10� �1��1.e5S �- S4e�p Z�
CONSTRUCTION'.INFORMATION
Additional work to orme under this permit—check a app y:
11HVAC f]Gas Tank Gas Piping _Shutters Q Windows/Doors
11 Electric 0 Plumbing Sprinklers E]Generator M Roof ® Roof pitch
Total Sq. Ft of Construction: 2(oZ3 S . Ft.of First Floor: -.6 23
Cost of Construction:$ �� ( 00 Utilities: Sewer Septic Building Height:
;O.WN`ER/LESSEE: CONTRACTOR:
Name':�'�.5 ZWCe Name: V41UyLX0 ��e(
Address: $Z_-�O S" �?4� Company:
City:_VoyA, 6A C� "Q State: L- Address:a-466 50J LC��VTC_- S T
Zip Code:S4 Q'5� Fax: City: �>Ofgk kq--ke. State: 11:'—
Phone No. — 14`4— Z 3 0-a Zip Code: Z`I4 S 3 Fax: YJ (Pt
E-Mail: P f IN Phone No.Z' Z s r 2 Q
Fill in fee simple Title Holder on next page(if different E-Mail:00eC06 5A*W_0(�A n0 3 SCbJ\tCe$e3hs� o'
from the Owner listed above) State or County License: t330 623
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION
DESIGN ER
ENGIN EER• f Applicable
e MORTGAGE COMPANY:e _Nof Applicable
Name: Name:
Address: Address:
City: Si-We: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDE . f Not Applicable BONDING COMPANY: _ of 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.
C.l(0 OX60AO�
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORID STATE OF FLORID Ce
COUNTY OF S V Cry COUNTY OF
The for oin instr n was acknowled a before me The IN
in instru n as acknowledg$e before me
this 3 d y of �� .201 1 by thisy of 201� by
Name of person making statement ame of person making statement
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identificatio
Prod ced " Produc f
_A
(Si nature of Notary Publi State of Florida) (Signature of Notary Public-Ate of Florida) _
vt"u 25. . "' F Cl2 �,!{E-.t�'J'•. t tGr: G�'d11 M
Commission No. "� (65 S E3 CaQyit � commission No. : . ; SI
e- O%qN iSS90!�!�#FF925'1 1
MY COMMISSION##FF925'171 e_
-;"� ' ': EXF°IriES DECembe, 17,201
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Fo, `.`' EXPIRES December 17,201 �" cP ca CO
(407) 9"153 Flori allotaryService com
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17