HomeMy WebLinkAboutSmith roof appAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
!0 Date: —1q-2—t Permit Number:
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: 42 71 i� P r c
Property Tax ID #: 130 L06 (3-- ®Q — Q Lot No. —17
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
i',
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
(Affidavit required)
Additional work to be performed under this permit —check all that apply:
_Mechanical Gas Tank —Gas Piping _ Shutters Windows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator Roof
Total Sq. Ft of Construction: ??
Cost of Construction: $ Z Q.
J
e
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic Building Height:
Pond
Pitch
OWNERAESSEE:
CONTRACTOR:
Name_ (__r i e-
Name:
Address: 21 (j (��>� 1 r �� f
Company:
City: Stater
Zip Code: Fax:
Phone No. fe, E-
Address: _ tj - l�l
City: Lr e State:
Zip Code: 2 +✓ .1 Fax:
Phone No 'Z_..
E-Mail
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
State or County License
It value of construction is Z5U0 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.
_ Not Applicable MORTGAGE COMPANY: _ Not Applicable
DESIGNER/ENGINEER:
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 conflicts with any applicable Homeowners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Homeowners 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 commencine work or recording your Notice of Commencement.
nature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORID ,
COUNTY OF , - A1r a R _--
Swor to (or affirmed) and subscribed before me of ZPhysical Presence or Online Notarization
this U day of 20a� by
rh_J,',,)hC1,k_. � i i Ck Y�
Name of person making statement.
Personally Known ✓ 011 Produced Identification
Type otification Produced f I ra
ma,3�' ]� rX I.
(Signature of Notary Public- State of Florida):. , of Flos4d�
public state
r �iatary sandetson
Commission No. Seal) , AmamanpskonGG2ttz
se56472�+2a22
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
BATE
RECEIVED
DATE
COMPLETED
Rev 5/20/21