HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR
Date: A ' 11
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: Roof
PROPOSED IMPROVEMENT LOCATION:.
Address: Address: �` N �l.L.. ZQ TDr t ve
Legal Description: WIYAMIM U i vi
(?. 2 -131 tR
Property Tax ID #: Li 511 — T1 VCD7- D
Site Plan Name:
Project Name:
Setbacks Front Back: F
TION TO BE ACCEPTED
Permit Number: �7nq_M�7
RECEIVED
Nit AppliCati n APR 0 4 2018
ST. Lucie County, Pgrmi mg
mercial Residential
- Unl+YI, - 131 k R e- l/z L-or
Vol
Side: Left Side:
Lot No. (F
Block No. G I Z
DETAILED DESCRIPTION OF WORK:
�a4 arc �X 1 C'NG;N "SKr' 46`. A. Jr- MA9,C-b ``�,,tr `
1.. _ !s r QC_ A"tS V Prvr it{, lc1)S'.J al Sr pldjbili� cA>
CONSTRUCTION INFORMATION:
Additional work to be nertormed under tispermit—c ec a apply:
11HVAC Gas Tank Gas Piping _ Shutters Q W' doors/Doors
11 Electric ❑ g nU P Plumbing S rinkler I ElGenerator Roof Roof pitch
Total Sq. Ft of Construction: /W I S . Ft. of First Floor: /&!(
Cost of Construction: $ '� Utii ities: Sewer Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
Name:
Company:
rs
Address: IQ 19 1 �OeQ-I�
City: ES A-, State: FL!
Zip Code: 33q ()lS9 Fax: N J G I
Phone No. tJ Li Li4 -' LQ 1 S3 i
E-Mail: Z2)Z. •I� l IS
//11
Address: T5 5. 1 0 S U (
City:
Zip Code: t3 _ pp Fax:
Phone No. -?,?L1— Z$$
J (.
r State
(V
Fill in fee simple Title Holder on next page ( if different ;I
from the Owner listed above)
E-Mail: I uTTZ-
State or County License: CCC 133LYJQD
14 L
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
.;SUPPLEMENTALCONSTRUCTION LIEN. LAW INFORMATION.:
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City: State: I
City: State:
Zip: Phone
I
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: _Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
I
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 prio I 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 Buildi g Codes and St. Lucie County Amendments.
The following building permit applications are exempt fro undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, walls, sign , screen rooms and accessory uses to another non-residential use
WARNING TO OWNER: Your failure to Record a otice 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 obta n financing, consult with lender or an attorney before
commencin work or recordingour Notice of commencement.
ignature ofgCyder/ Lessee/Contractor as Agent for Owner I Signature of Contractor/License Holder
STATE OF FLORIDAc'� /�
COUNTY OF (J�_ Ll��ll�
The foing instrum t acknowledge before me
this —day of 20 by
(Z. I'.I (��.�C► Q
Name of person making statement
Personally Known OR Produced Identification
Type c Id�fica�c�n„�. � i Ce5�
Produced � (� ri �
(Signdture of Notary ``Public- State
Commission No. 111 -1
REVIEWS I FRONT ONING
COUNTER I REEVI W I S F
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17
STATE OF FLORIDA l pp
COUNTY OF. Luc l l-
The for mg instrume t as acknowledg before me
this —day of 20 � by
ap-y n ZDro_ � rno-rabn
Name of perso aking statement
Personally Known OR Produced Identification
Type of Identification
Produced
_ Y ,•{ I I, , L v
n
f Notary Public- State of FloridaM. -77Q INNo. I " (Seal)
UN
REVIEW PLANS
I VEGETATIEVI WON I SEATURTEV EWLE I MREV EWVE
CYNTHIAM. NUTT I
MY COMMISSION # GG 1779U P
EXPIRES: January 22, 2022 iy