HomeMy WebLinkAboutAPPROVEDCasey Permit App ( Low Slope Roof St.Lucie )All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
E L CIF .EE
Permit Number;
Building Permit Application
Planning and Development Services
60dong and Code Regulo tlon 0i vision Commercial
2300 1VirgniaAvenue, fort Pierce FL 34982
Phone, (772) 462-1553 Fax: (772) 4E2-1578
Residential
PERMIT APPLICATION FOR,
PROPOSED IMPROVEMENT LOCATION:
Property Tax ID #: p�' -' Lot No.
Site Plnri Marne: Cce:( 1�jn Block N o�
Project Rarme; ._ -
DUAI LED DE CRI P71 O OF WORK:
I� cd-• 1C (C)O }
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed udder this permit — check alb that apply:
_Mechanical _ Gas Tank — Gas Piping T Shutters _
Eledri-c —Plumbing —Sprinklers — Generator
Total Sq. Ft of Construction; 1_11 Sq. Ft. of First Fleur;
Windows/DoofS Pond
Roof JIQ Pitch
Cost of Construction; S <X, Utilities: —Sewer —Septic
Building Height: I qY
OWNER/LESSEE: CONTRACTOR:
Naroe ' Nana;
Addros.5; 1 ' 0 Company:'� r
pity; � k C"'M M State: 'i Address:!�DKA_ 61YR,_
zip Cade 1_)to Fax, Clty, $tat '
Phone No, -' 4 Zip Cade: i ._. —_ Fax
E-MaH: CL-30,-N `: rkA0 q Phone No .
Fill I n fee s im pl a Title Holder on n ext page � if d Iffe re rat E -Ka ii C � �[: � Ii
from the owner listed ab oae � State or Ccu
If value of construction is 25M or more, a RECORDED Nofire -of Comrnencernent is require4,
if value of HAVC is $7,500 or mare' a RECORDED Nut ice of Gamrnencement is required.
SUPPLEMENTAL CONSTR UCTIO N LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
Name:
Address:
City.
zip
Phone
FEE SIMPLE TITLE HOLDEFU:
Narne:
Address -
City:
Zip; Phone.
Not Applicahie IVIORTGAGE CC) MPANY.* Not Applicable
Name;
Addlres!5: _
State; City{: State
zip: Phone: —
Not Ap p I I ca ble
BONDING COMPANY.
Narne:
Address:
City,
zips Phone.
blot ,applicable
OVEN EEC/ CONTRACTO R AF F I DV IT: Appl i ra tl on ; s h e re by ma d e to obtain a p-ermit to d o th a work a nd installativ n as i ndicated.
I co rtify th a t n o wo rk or installa ki on ha s corn me nced pr for to th a issuance of -a perm it.
St, Lucie CountCountv rn aloes no representation that E5 gra nVtig a pc rm it will au thor izu the a rmit holder to b uild the subject st ru ctu re
which is in conf I ict vwith any applicable Horne Owners Asionation rules, bylaws or an9cov+enants that may restrict or prohibit such
structure. PI easy consult wrath you r Home Oar ners Association and revi ew your doe d for a ny restrict i o ns try hash m ay app ly_
I n coo si d eratio n of the gr;i nti ng of this requ ested perm i k, I do h ereby agree t hat I will, i n al I re spectsr perfoi m the work
i n accordance with the a p p roved plans, the F I orida RuI I d i n$ Codes and St, Lucie County Amend-ments-
The followi n g bu ilding pe rmit a p pl ication 5 a re exempt from u nde rgoing a fu I I core ckj rrency-raview- room a d d iti on!Sr
aoce55ory strUCturesr swi rrtm ing p ools, fen to ri, rival Is, i ig ns, screen rooms a rid acce.s5-ory u ses to a nuth er n o n •residentia I use
WAR N I N G TO OWN F R: Yo u r fai lu re to Re co rd a N otIce of Cornmenoe meat maV result In paying twice for
irnpruvernents to your property. A Notice of Commencement Mast be recorded in the public records of St,
Lucie County and posted on the jobswte before the first inspection. If you intents to obtain financing, consult
with lender_og a attorney before coma -ending work or recording vo Notice of Cornr nencement-
Signature of der' Lesste/Contractor as Agent for Owner
STATE OF LORfIDA
COUNTY OF
"IV n to (or affirmed and subscribed before me of
Physical Presence or Online Notarization
thl-5 I l day of -'_�Qro!j r 2!02Q by
Name -of person makixis statement,
Person -ally Known �_ OR Produced I den ki fi catlon
Type of Identification
Produ-cod
I Sign at ure of Nota r�f P u
Commission No -
FEE Vi EW5
DATE
RECEIVED
DATE
COMPLETED
ear,
j
Sign aiure of Cfi ntractor/ License H al de r
STATE OF FLORIDA e7
COUNTY' CIF ,
Sv n to (or affirm@d) and subscribed before me of
Phy5.ical Pre Bence or O n I i ne Nota r ization
this day of JOA OC—Q 202Q by
Na rn a of pe rson :n-a k i np, &tateme nt.
Personally Known � OR Produced Identification
Typs of Identification
Produced -,
I SiE na to refof Notary Pki bl ic- State
�}Y � II�JP � �L ���V •7F� c � � I��
P Kelps ornmisslon "Jo,
K MY CDv'n"P4j#P GG 308996
EXo=f 3 011--ift2023
INotaryr Public 51"
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