HomeMy WebLinkAbout8006 Building Roof permitAll APPLICABLE IN F MU T BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
ff c T" L c P;� w`=- 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
IMPROVEMENT LOCATION:
Address: p 6Cj R L N Ke-lq- ' a 1 t_,
Property Tax ID4: -_-�/G oc�� nc)o 9
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
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
Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction: �-
Cost of Construction: $�
Lot No.
Block No.
--k
Shutters ��Windows/Doors_ Pond
y/r
Generator �L� Roof 1112, Pitch
Sa. Ft. of First Floor:
Utilities: _ Sewer
Septic
Building Height:
OWNERAESSEE:
CONTRACTOR:
Name A k-1 e.- , n,
Address_ /_ 9 %�
Name:
Company:
City: t?-1 t `e/t-�__ State:
Zip Coder I Fax:
Phone No. t22 2. E-
Address:
City: _ ;Lu''C
Zip Code: Z-�� Z-
Phone No
State:
Fax:
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail
State or County License �JC
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.
DESIGNER/ENGINEER:
_ Not Appliicable
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 an 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 lanrfpr or an attnrnev heforp commencing work or recordine your Notice of Commencement.
nature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORID ,
COUNTY OF
Swor to (or affirmed) and subscribed before me of Zhysical Presence or Online Notarization
this �t day of QC.f7&;' 20%L by
Name of person making
statement.
Personally Known ►� OR Produced identification
Type of I ratification Produced
(Signature of Notary Public- State of Florida)Notary ..
pu Stale
Sea])�U Ama da A Sandetso�so
Commission Na. o0 2Sz
c]�,m,ss,on
o4i292022
4
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Rev 5/20/Z1