HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: � Y
RECEIVED
• APR 2 3 2021
Building Permit Application Rwmitthng Dapartmi�nt
Planning and Development Services St. Lucie County
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax: (772)462-1578 Commercial Residential X
PERMIT APPLICATION FOR: Roof
PROPOSED IMPROVEMENT LOCATION:
Address: IgQ5 NIL�U^ Lo km'd e Dr Polen C11W , -L _34qqQ
/
Legal Description: Q rl dQ e 1 D 1 O+ 4
Property Tax ID#: qq-2 15 - 9oZ -OOO(o - CCO-q Lot No.
Site Plan Name- nn /� Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILEDDESCRIPTION-OF WORK:
re-move tx �s4 i nG Sh 1 r,q e_ roo-P and re-P I ace Lu l+k
clew 5v ,e+a I rcoa '-
[CONSTRUCTION-IN
Aciclitional work to e e orme under t ispermit—checka apply:
OHVAC E]Gas Tank Gas Piping _Shutters Q Windows/Doors
Electric 0 Plumbing Sprinklers E]Generator W1 Roof Roof pitch
Total Sq. Ft of Construction: S . Ft.of First Floor:
r
Cost of Construction:$ Z r �n 0�• Utilities: _Sewer I Septic Building Height:
OWN ER/LESSEE: ' CONTRACTOR:
Name_ Ct+ 1 C K M o r+t Cl Name: Jamie Cisco
Address: 7,_y05 NUJ La �e r—f&je_ Q r Company: Sunshine Roofing, LLC
City:P6TV C I --U State: F Address: PO Box 1083
Zip Code: 34gq() Fax: City: Palm City State:FL
Phone No. — — 0 Zip Code: 34991 Fax:
E-Mail: Phone No. 772-260-8195
Fill in fee simple Title Holder on next ge(if different E-Mail: sunshineroofingllc@gmail.com
from the Owner listed above) State or County License: CCC1327796
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:Jamie Cisco
Address: Address:
City: State: City: Palm City State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address:Po Box 1083 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 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 an 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.
K
Sign ure o Owner/Lessee/Contractor as Agent for Owner Signature of C ractor/License Holder
STATE OF FLORI A STATE OF FLORIDA
COUNTY OF "A-Id-\ COUNTY OF
Th r ing instrui ent via acknowledged before me The rg 'ng instr ent w s acknowledged before me
y of 20_a by this of 20 by
Name of person making statement Name of person king statement
Personally Known OR Produced Identification 11 / Personally Known OR Produced Identification
Type of ldentificaAlion Type of Identification
Produced Produced
(Sign ture of o - = (Sign 13
KN.
RISTIE D� , KRISTIE DYE
Commission r�u�c"': Q MY COMMISSION#GG939?tQQ
ISSIONk'GG 9200 Comm :*= e
02
EXPIRES:December 11,2023 c: ber 11,ew
Eod� Bonde4TtmNotaryPubricUnderwrite�s f�F`�o'� BondedThniNotnfyPuD6cUndervAitero
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17