HomeMy WebLinkAboutre-roof 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 Commercial Residenti:��
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR:
Address: bl Vd -Z�Wn4-DEn 6eaj)
PropertyTaxlD#: qsoa-50- wi� -CCU Lot No.
Site Plan Name: Block No.
Project Name:
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E UP, M.
POWE
New Electrical Meter
Second Electrical Meter
Additional work to be performed under this permit- check all that apply:
—Mechanical — GasTank —Gas Piping — Shutters
(Affidavit required)
Windows/Doors Pond
11,7
Electric Plumbing Sprinklers Generator Roof --L Pitch
Total Sq. Ft of Construction: 10 t) T Sq. Ft. of First Floor:
Cost of Construction: $ 157400 Utilities: . Sewer _ Septic
Building Height:
51, 66M "R,�
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Name
Name:
Address: KA Kle� 6NO
Company 1.0 /Z z k(,)- V/QG)f', 1_\
-Address: e(DL S-LD CCO& W t
ity: Cen P--Xa(,h State: 4-
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Zip Code: cpl��o Fax:
City:r_� T ta I /kT, U-� N State:.f
Phone No. E-
ZipCocle: ��90(72�' Fax:'
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Phone No 4
Mail:
Fill in fee simple Title Holder on next page (if different
E-Mail e-)tL OL L
from the Owner listed above)
State or CounCy License C t r� -�:>
If value of construction is 2500 or more, a RECORDED Notice ot commencement is requirea.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
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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 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 lanrlar nr an attnrnev.hefore commencine work or recordine vour Notice of Commencement.
MOT -
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF
Swor to (or affirmed) and s4�b�scribed before me ofy
Physical Presence or Online Notarization
this day of ��� Q!�6 20 by
c:�) AcLi Lb L-,,i�2 l
Name of person aking stat m\e
Personally Known O Pr 'fi uced Iden cation
Type of Identification Pr duce L ✓L
(Signature of Not blic- a e of Florida)
y Kenny Henzow
Commission No. (Seal)
Notary Public
y State of Florida
Comm# HH087667
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Expires 2/1/Z025
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