Press Alt + R to read the document text or Alt + P to download or print.
This document contains no pages.
HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR Al
Date: .0A
'SCANNED
T � H BY
Building
PLICATION TO BE ACCEPTED I ''nn
Permit Number: ` ®Q,' Oy's
rmit 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
PERMIT APPLICATION FOR: Roof I
Address: 1 y u ?ez r I i a m QN,
Legal Description: T _koS un
Property Tax ID#: 1q/q-'7O/- ©/(��- C)
Site Plan Name: f C& ' I
Project Name: _ A t!:�CY1
Setbacks Front Back: Right Side
,era o J tL. P_*- i -, , q 4n 4t V�L f O O -�
se.e,,,,,, Al um; uJ-tA . o 08,4 ,
Left Side:
Residential
Lot No.
Block No.�
Haamonai worK to De errormea unaer tnis permit- cneck all apply:
11HVAC L _ Gas Tank Gas Piping _ Shutters L]Windows/Doors
Electric ❑ Plumbing Sprinklers Generator W Roof Roof pitch
Total Sq. Ft of Construction: Yq S . FtFt. of First Floor: !J M
Cost of Construction: $ -=/a� e)0 , U O Utilities: Sewer Septic Building Height:
I
�-
b1lNERjLE�SSEp
CtIUTRACTi3R r 7��0
kz
Name L—
N ime: �"�`�v�'��_1.�.;
Co pany: 0O�r `�GC-of -s ]�_C
Address:-�1� u o�<� 1 o.�rl e n�-
City: �-y- :t ,t Stater -
Adtl-re�ss: a�5lj ��S�-
Cit 'I: rr�S' -)- sa— . 1—�-K (,-1-�L- Stater.
Zip Code:'?+4 °i Li 01 Fax: rJ
Phone No. +1'"1 a --11 3' 3b(0
Zip Code: 1----Jt4 c)5A Fax: t,1 �
E-Mail: -9—vlk.S �k 1k,
Pho�eNo. "ll-11�.-
E-Mil:
Fill in fee simple Title Holder on next page ( if di ferent
State or County License:
from the Owner listed above)
It value of construction is.52500 or more, a RECORDED Notice of Commencement is required.
;
moil
DESIGNER/ENGINEER:
Name:
Not Applic 'ble
MORTGAGE COMPANY:
Name:
Address:
Not Applicable
Address:
City:
Zip: Phone
State: I
I
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Not Applicalble
I
I
BONDING COMPANY:
Name:
X-Not Applicable
Address:
City:
Zip: Phone:
I
I
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is h�reby 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 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 Associa ion 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 froI unredergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, walls, sign s,lscen 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
mencement must be recorded and posted on the jobsite
improvements to your property. A Notice of Com
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or eco rIg your Notice of Commencement.
I
Signattre of Owner/ Lessee/Contractor as Agent for Owner
Signat re of Contractor License Holder
STATE OF FLORI
STATE OF FLORID�/
COUNTY OF_ �� ,-Ur,/.�,
COUNTY OF J y. f e !�,
The forgoing instrument was acknowledged before me
The for oing instrumt was acknowledged before me
this c3G day of �2i_ 20/� by
this day of 20 /A by
Name of person making statement
Name of person making statement
Personally Known )% OR Produced Identification
Personally Known -A OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signatu a of Notary Public- State �f Flori
(Signatur of Notary Public- State of Florid
CommissIS-01 OP al)
r Commission 1444
� r ru MARK KENNY
Commis �i t Commission#GG14449 (Seal)
,. � es p m r 19, 20
Expires September19,2021
''FOF�o��v ladodThu suag.cNomrrsorno»
OF F�
REVIEWS
FRONT
ZONING
SUPERVISpR
PLANS
EGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW I
REVIE
REVIEW.
REVIEW
REVIEW
DATE
RECEIVED
DATE
�lo
COMPLETED!
tev.8/2/17 I