HomeMy WebLinkAbout11876 Willis Road - Metal ReRoof Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
•
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Residential
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: \VS-1 LC
Legal Description: '� 35 3c1 S `L_ AG G♦^ W `IZ o� 'L-. 2 Cat NW sW `l � LS3
Property Tax ID #: 2 '��9 32yc �� V� C2L 2 Lot No.
Site Plan Name: Block No.
Project Name: L-lzr
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
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CONSTRUCTION INFORMATION:
rtiona wor to e e orme un ert ispermrt-c ec a appy:
❑Gas Windows/Doors
1iHVAC Gas Tank Piping _ Shutters
Electric OPlumbing Sprinklers Generator ,Roof 'w Roof pitch
Total Sq. Ft of Construction: \ iuc�)10 S Ft. of First Floor:
E]Height:
Cost of Construction: $ \`��� Utilities:Cn Sewer Septic Building
OWNER/LESSEE:
CONTRACTOR:
Name:: -d V-4> Si —
Name "\k,& L + l Cep
Address: X\(31h Wt\\\S QA.
Company: s"'w"FkI �c
City: Srncz-1- eCc. Stat V—
Address: ') 'S
City: \f-cy— F 'ET='n State'.�-
Zip Code: 3`i�yS Fax:
Phone No.
Zip Code: 82gt00 Fax:'-1
E-Mail:
Phone No .-t19 --QLk OAOI
Fill in fee simple Title Holder on next page ( if different
E-Mail: \(�o
State or County License: Q C1-- l
from the Owner listed above)
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
I SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Address:
City: State:
Zip: Phone:
BONDING COMPANY:
Address:
Zip:
_Not Applicable
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to 13o the worK ono In51AlidUVII do
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
structure. Pleafsle c consult any
with pyolurHome Owners AssoOwners Association
iation Ind review bylaws
our deed for any restrthat
ct onmay
wh crestrict
maor
alprohibit such
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
__ -.__ _.__I. __ _____�: _.. ..,...� nl...:..,. „F r,.w..o.eement
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Milo §an�Apr 26,202115;04 EDT)
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signatu ntra�older
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OFJSVs
The forgoing instrument was acknowledged before me
The forgP�o�:�g instrument was acknowledged before me
"8'ay by
this% day of Agri_ I 20� by
this of N1Q!!!1C_, 20?:
(hZc_y_ 1 S0.nAtTL�
�Or\'J 1�D �S
Name of person making statement
Name of person making statement
Personally Known OR Produced Identification X1
Personally Knowh-2 OR Produced Identification
Type of Iden 'fication
Type of Identification
Produ
Produced
(Signature of Notary Public- Stat
ture of Notary P li -. t t .Pt:kl➢ijda'�l^'"°e'
L7 taVc^j'•••.. MICAELA DEEGAN
Commission No.� 1.?J (•dam I�atary Public - State of
, Plotary public State of Florida <'y
Iw1da, fission No. ,."� �", nla�raseC�ea�
O 253a06
+. ` Commission # GG 93
`0 h My Comm. Expires Dec
6 t M,, Commission 1
I, 2023 �a ' =;moos aW1412o22
• Bonded through National NotA
ry
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Rev.8/2/17