HomeMy WebLinkAbout6012 Roland CtAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 10 -Z) - 2-1 Permit Number:
LLL�
-
L. r_ L rt - Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential r,Z-
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: LvOI Z. FpVw`rd G"i r _P1 C.CCE i EL 3qq ' 1
Property Tax ID #: J 30 2- 51 C) '`C) I C)T —Cco —1
Site Plan Name: ayewo08-
Project Name:
DETAILED DESCRIPTION OF WORK:( rA.,-,r�t�P V r 0 ( VlArill
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit - check all that apply:
Mechanical Gas Tank _ Gas Piping _ Shutters
Electric Plumbing _ Sprinklers
Total Sq..Ft of Construction:
Cost of Construction: $ 1 OIJ�J •�
Generator
Sq. Ft. of First Floor:
Lot No.
Block No.
Windows/Doors —Pond
Roof Pitch
Utilities: —Sewer —Septic Building Height:
OWNER%LESSEE:
CONTRACTOR:
Name toaim Uif
Name: ;`-- 1"
Address:
Company: Ytj Tr i
City: 'E" State: :,
Zip Code: �J ��$ Z Fax:
Phone No. rl� -• S
E-Mail: b, a GL
Address: V-" l •�.«�L -a��
City:b State:
Zip Code: Fax:
Phone No (� �- 7 1 �� Z `-ti
Fill in fee simple Title Ho der on next page ( if different
from the Owner listed above)
E-Mail - i
State or Y Count icense
if value of construction is 2500 or more, a RELUKUEU Nonce oT Lommencemenl 1b rnquucu.
if value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER:
_ Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City:
State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
_ Not 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 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 vour Notice of Commencement.
Signature of Owner/
STATE OF FLORIDA
COUNTY OF
as Agent for Owner
Sworn to (or affirmed) and subscribed before me of Physical Presence or Online Notarization
this day of , 20_ by
Name of person making statement.
Personally Known _. _/ . OR Produced Identification
Type of Identification Produced _4 f 4� /1
of Notary
Commission No.
,•�".P'%,
KIARA S FIGUEROA
` $Nolft^blic-State of Florida
�* •=
Commission # HH 51970
My Commission Expires
0n 1%�`a
October 08, 2024
REVIEWS i FRONT
COUNTER
DATE
COMPLETED
ZONING ANGRO
REVIEW I S REVIEW OR I REV EW NS I VEGETATION
I $ REVIEW I REV EWVE