HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONZ4 -
ALL APPL CAB E IN-0 MUST BE COMPLETED FOR APPLI
Date: SCANNED
do 111M
Building Per
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:IAL'A U Z)r.,, Jffb
Legal Description: A d rn I I I V 1
I r�T In / A -,-7-2►_ C:�c�I�
TION TO BE ACCEPTED C�N-nN41 Permit Number:
RECEIVED
it ApplicationLS
Z"ce
0 4 2018
untY, Para
Commercial Residential
- 1)nif-Ti'i1
1h
Property Tax ID M L151 � - $11— =7- MD-1 I Lot No.�
Site Plan Name: 1 Block No. �Z
Project Name: I
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
y
S- CcC__ .,a,i.S S—_ t/ /_Z4St* lq ,r We5L (�4r
FCCONSTRUCTION INFORMATION: I
Additional work to be ertormed under tispermit—check all that a ply:
11HVAC Gas Tank ❑Gas Piping _ S utters a Windows/Doors
11 Electric 0 Plumbing Sprinklers L_J G nerator Roof 3 I Roof pitch
Total S . Ft of Construction: S . F . I r'3C q �'X ttj o first Floor: /c� t
Cost of Construction: $ 9b0000 Utilities. —S- wer Septic Building Height: /7
'OWNER/LESSEE:
CONTRACTOR:,
Name — �' )
Address:?y5 s�)Q Lu r i (l
Name: 1
Company: o0;
City: State:
Zip Code: Fax: NIP
Phone No.
E-Mail: R\/e, m
Address: I �,M NW-1) 3r.
City: WI-M State:�L.
Zip Code: hJLi � Fax: M
Phone No.l -1 — ZS f Z.
E-Mail:1
Fill in fee simple Title Holder on n xt page (if different
from the Owner listed above)
State or Conty License:
IT value or construction is :�z5uu or more, a RECORDED Notice of Commencement is required.
.SUPPLEMENTAL. CONSTRUCTION LIEN,IAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY:. _ Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City: I
City:
Zip: Phone:
Zip: Phone:
I
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby
I certify that no work or installation has commenced prior to tF
St. Lucie County makes no representation that is granting a per
which is in conflict with any applicable Home Owners Associatic
structure. Please consult with your Home Owners Association a
to obtain a permit to do the work and installation as indicated.
issuance of a permit.
e the permit holder to build the subject structure
or and covenants that may restrict or prohibit such
deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I doh reby agree that I will, in all respects, perform the work
in accordance with the approved plans, the Florida Building Cod sand St. Lucie County Amendments.
The following building permit applications are exempt from and rgoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, walls, signs, scree rooms and accessory uses to another non-residential use
WARNING TO OWNER: Your failure to Record a Notice f Commencement may result in your paying twice for
improvements to your property. A Notice of Commen ement must be recorded and posted on the jobsite
before the first inspection. If you intend to obtain fina sing, consult with lender or an attorney before
commAncing work or recording your Notice of Comm ncement.
of Owner/ Lessee/Contractor as Agent for owner
Signature of Contractor/License Holder
STATE OF COUNTY OF FLORIDA �. LI �C' i II COUNTY OF STATE OF FLORIDA a f LI 1 C 1 -
The ng instr men wa cknowledgebefore me The g instrumen knowledge before me
this ay of 20 by this L ay of 20 by
DI �nn ion ov Pn .1 r(���� r�10 5-11un
Name of person making statement / Name of person aking statement
Personally Known �/ OR Produced
Identification V Personally Known �nOR Produced Identification
Type of Prod celd��,` 1 C_� le— Produced
Type of Identification
r
(Sign ture of Notary Public-- State of
of Florida )
Commission No 1 -/ 19 (Seal)
REVIEWS I FRONT
COU TER I ROEVI NING W I S REVIEWOR
DATE
RECEIVED
-
DATE
COMPLETED
Rev. 8/2/17
CQMIAM. NVIT
MYCOMMISS10N#GG177919
;,g -
EXPIRES: January 22, 2022
oi.'r°�;,• SOnd¢dThNNoWPubftUndenrtfW
Nm�arn..noii-
(Sign6ture of Notary Public-(S,tate of Florida )
Commission No - (I (Seal)
PLANS ;E VIEW I VEGETATION
I S REVEWLE I MANGROVE EVIEW
C'0*I'! ANl.NUTT
! #Y t�; ,IAMIS QN IP G.G 177910
:FIRES: January 22, 2022