HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential X
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax: (772)462-1578
PERMIT APPLICATION FOR: 0�ngt&
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PROPOSED IMPROVEMENT LOCATION:
Address: 6 03j'�
Property Tax ID#: 1301- 3 - �j '3� 0��— � Lot No. 020�
Site Plan Name: Block No.
Project Name: ,( �Ie(,f (1Ud
DETAILED DESCRIPTION OF WORK:
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit—check all that apply:
_Mechanical `Gas Tank _Gas Piping _Shutters _Windows/Doors/ Pond
_Electric —Plumbing _Sprinklers _Generator ✓ Roof 6119,9, Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $��� j } Utilities: —Sewer _Septic Building Height: v
OWNER/LESSEE: CONTRACTOR:
Name Name:Luis Quinones
Address: 3 Company:Rhino Roofs&General Construction Corp
City: � �'/�{' Stater Address:865 S Kings Hwy
Zip Code: J4,q ) Fax: City: Fort Pierce State:FL
Phone No. 7`1,�- Zip Code: 34945 Fax:
E-Mail: Mao%,fli j't�{S Phone No 772-446-1139
J i
Fill in fee simple Title Holder on next page(if different E-Mail info@roofsbyrhino.com
from the Owner listed above) State or County License CCC1331472
If value of construction is 2500 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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: —Not Applicable MORTGAGE COMPANY: Not Applicable
Name:N A Name:N/A
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name:1`A Name:N/A
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 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 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 FLORIDA STATE OF FLORIDA {�
COUNTY OF � . ( � P COUNTY OF a�.
Sworn to(or affirmed)and subscribed before me of SwoJn to(or affirmed)and subscribed before me of
✓ Physical Presence or Online Notarization Physical Presence or Online Notarization
this012A day of M ' ,202frby this &7 '%ay of 202-T by
&D i r&-YLPS LAAiS `'(A.(1-)6 tl��
Name of person making statement. Name of person making statement.
Personally Known V OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Prodixed Produced
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(S-idiiaturt otftrr rublic- §I r' gnatur otary Public-St t a' kAe`
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Notai F ubi StWe cf Florida ra
Commission No.
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�` m 1e Fe>en 4nmission No. 6 (Se s're Fi ti C'arirr r GG 24 6
v x; MY Corrnr i 5_n;;GG 240686 Expuos07/L2! `foicl� Expires 07122,12022
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