HomeMy WebLinkAboutReRoofApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: a„
� 'Laa Permit Number:
91-1rcoo
L `CAUL
wilding Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia A venue, Fort Pierce FL 34982
Commercial Residential_
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION
Address:
Property Tax ID #:
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed
_Mechanical
— Electric
under this permit— check all that apply:
_ Gas Tank
_ Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $
OWNER/LESSEE:
_ Gas Piping
_ Sprinklers
- - Lot No.
(Affidavit required)
_ Shutters — Windows/Doors
_Generator Roof Pitch
Sq. Ft. of First Floor:
Utilities: _ Sewer — Septic Building Height:
Name viol% &sl k"
Address: SCb�
City: � V a c rc- State: �t_
Zip Code: 3 5:, Fax:
Phone No. 27J —d
Mail � & 9
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
CONTRACTOR:
Block No.
— Pond
Name:
Company: f;�l7gna^ I T eC
Address: &S-s
City. 9- -4- Pig %_ e_ a
Stater
Zip Code:.31'� �`_7!;' Fax:
Phone No?Z4
State or County License
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.
te-��<3
SUPPLEMENTAL CONSTRUCTION
NER/ENGINEER:
Name:
Address:
City:
Zip: Phone
FEE SIMPLE TITLE I-BO
Name:
Address:
City:
ZIp: Phone:
LIEN LAW INFORMATION:
of Applicab
State:
Not Applicable
MORTGAGE COMPANY:
Name:
Address:
City:
Zip Phone:
BONDING COMP
Name:
Address:
City:
Zip'' Phone:
Not Applicable
Not Applicable
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 consu t 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 commencing work or recording our Notice of Commencement.
Signature -of Contractor - or - Owner Builder as applicable
STATE OF FLORID
COUNTY OF U e
Sworn to (or affirmed) and subscribed before me of
this day of jr20 �Jby P ysical Presence or Online Notarization
Name of person making statement.
Personally Known OR Produced Identification
Type of Identi-66tion Produced
of Notary Public- State of Florida)
Commission No. A,/�e->'3',7J- (Seal)
REVIEWS FRONT I ZONING
COUNTER I REVIEW
DATE
RECEIVED
DATE
COMPLETED
ff
Carfn M QuinonePublic State of s onda
My Commission HH 053277
Expires 02/15t2C:5
S REVIEWOR I REVIEW I V REVIEW ON I S REV EWLE I MANGROVEREVIEW