HomeMy WebLinkAboutBUILDING PERMIT APPLICATION90AINNED
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLRdA-1&N(9, 6pBE9A"CCEPTED
Date: Permit Number: I
RECEIVED
Building Permit Application
Planning and Development Services MAR U 5 2018
Building and Code Regulation Division ST. Lucie County
2300 Virginia Avenue, Fort Pierce FL 34982 Y drMitting
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: Roof
PROPC?SED li1lIPROVEIUIENT LOCATION. ,
Address: —1 SA---' F_l.l_ C lA q
Legal Description:
Property Tax ID #: ' 3y 19 - so) - Ol 0 a 00 0_ Y�
Site Plan Name:
Project Name:
Setbacks
Front Back: Right Side: Left Side:
1 DETAii ED DESCRIPTION OF WORK. `�,. , f
Q`M 2 X/1 Sp�"��1 Yi��� 1Z O ( - �'1 v� S��2 S m ��) G�� e-2 �J l � �' O p4 h 1�
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CONSTRUCTi3ON ,INF�RMAT10`IV
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itione workto e e orme under this permit - check a apply:
�HVAC Gas Tank Gas Piping Shutters ❑Windows/Doors
Electric ❑ Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: 1% . Oil S . Ft. of First Floor: fJ
Cost of Construction: $ f a crb 00 0 Utilities: _ Sewer Septic Building Height: F �
QUt/NER%I'ESSEE �:
CaINTRACTOR
'
Name
Name. — �;al. i; �r5 �'/_j�en&( n-)
Company:2 nnk �pf_�-OfiS
Address: 401 L,J . E) t 0 54
CityState: R -
Address: aSSC) SE 1�z r;'Li, !& j-
City'ra . I Sa x,_ C�-- State:
Zip Code:-8q 9 %3 Fax:
Phone No. -)-I a, - 11 %14 -
Zip Code: Fax: --,,1 �
E-Mail: V k bL.UVA Q a 7�1 (lC l i 60 M
Phone No.
E-Mail:
Fill in fee simple Title Holder on next page ( if different
State or County License: C .; 13 ai
from the Owner listed above)
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
I
DESIGNER/ENGINEER: Not Applicable
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:.
—A— Not Applicable
BONDING COMPANY: XNot Applicable
Name:_
Address:
City:_
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�t�n attorney before
commencing work QT7ecor4ing your Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signat re of Contractor/License Holder
STATE OF FLORIDA po !!�
COUNTY OF L
STATE OF FLORIDA pp jj
COUNTY OF LA C
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J , i-e
The forgoing instru nt was�cknowledged Before me
The forgoing instru ent was acknowledgecj,L3efore me
day 20f by.
this % dayof /,. 20/�' by
of C
this //�
�J/s1. � a r� •( ;//Ir'/�S7'�l/1 _S'tt1.
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(,G�l/J�. �� rs �1r1,2/S�r1� SY1'LJ
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Name of person making statement
Name of person making statement
Personally Known _a OR Produced Identification
Personally Known,k OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signatu of Notary Public- o #a�g orida �N
(Signatu of Notary Public- S ;U lor' a )MARKI�t�,Jj�
a � = # GG 144400
Commission No. * es
* * Cortmission # GG 144499
Commission No. E>r4ptwnbgr19,2021
o tQmber19,2021
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17
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