HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO UST COMPLETED FOR APPLICATION TO BE ACCEPTED -7 n-0
iDate: c Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: Roof
PROPOSED IMPROVEMENT LOCATION:
Address: C' ✓ S
Legal Description: - '� � e
Property Tax ID #:
Site Plan Name:
Project Name.
Setbacks Front ' °- Back: �-
Right Side:-(!5�-� Left Side:-40—
Lot No._
Block No.
DETAILED .D.ESCRIPTION OF" WORK
CONSTRUCTION INFORMATION:
Additional worK to e e orme under is permit- c ec a apply:
�IHVAC 1, Gas Tank ❑Gas Piping _ Shutters ❑ Windows/Doors
Electric 0 Plumbing Sprinklers E] Generator 0 Roof -ll Roof pitch
Total Sq. Ft of Construction: 2 (' 8& 0 S . Ft. of First Floor: Z 6 ? 6 Yr
Cost of Construction: $ 22, r S 005 Utilities: Sewer 0 Septic Building Height:
ODUNER/LESSEE
CONTRACTOR:
Name a
Name: tin 11 6C
Address: 'R %A 7- e.ec%L� F
Company: S 4yv
pl. z
City: ___ 5 C.r State:
Address:
GG S
Zip Code: 3 Ci Fax:
City: SL_
StaterL
Phone No. �j 2 - r0 '' at( ��
Zip Code: Ci S- 3 Fax:
E-Mail:
Phone No. 2 S1 -
s� Lf �'
Fill in fee simple Title Holder on next page ( if different
L5
E-Mail: C� (Ne c-6 11 s L"7 zyn
Q rlj Ge3
from the Owner listed above)
State or County License: rt
o
3' ' 2
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
,SUPPLEMENTAL CONSTRUCTION.'LfEN,L'AW<IN'FORMATIO'N:.;
DESIGNER/ENGINEER: of Applicable
MORTGAGE COMPANY: of Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: N p icable
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 is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners 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 your paying twice for
improvements to your property. A Notice of Commencement must be recorded 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 vour Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STAOUTE OF FLORIDA
�1- ���FLORIDA
COUNTYOF
COUNTY OF 6 i , Ljx�,"
The for ping instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this day of 0G•A-06e,-- 26 -by
this ;�_ day of 0C4Ly:, 6 ,eo-' . 20JL-by
Name of person making statement
Name of person making statement
Personally Known AR Produced Identification
Personally Known a_— OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature o tary Public- Sta o FI ri
tur�e of Notary Public- State of Florida
Commission, o. e�
Notary Public -State of
�SPf:V PVB LETTE BLAIR-ALEX60
`
nER """"'
`, m ission o. �Q ;;ps °�a�;,,(SW► ETTE BLAIR-ALEXA
lori a ;° : Notary Public - State of
5
Commission FF 995
'�Comm. Commission
99 » -
+ Commission # FF 995
Ives Se
2020 y Comm Expires RAP A
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UPERVISOR
REVIEWS
FRONT :
PLANS
VEGETATION ,
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17