HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONQ
ALL APPLICABLE INFO cM,/UST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
-7 Date: 97 J� Permit Num
SCANNED
BY
•
• __ �..; St Lucie County
Building Permit Applicatioi
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 -
Address:
Legal Description:
65-<�Q51
RECEIVED
MAY 0 12018
ST. Lucie County, P@rmittin9
Residential X
Property Tax ID #: -L-H e cs - -1, 0-1 - Oy (0 9 - U O (� rj Lot No. J I
Site Plan Name: I ?:�, +-� U Block No. 5
Project Name: r0 1 ��
Setbacks Front Back: — Right Side: Left Side:
Vic? VA uv 4- 4_: i s41 n � i ,�� c. t-o crL' � /-P- P/ 5-kAfx11;,5 Sera ew /-�—
E1HVAC
Electric 0 Plumbing ❑Sprinklers Generator NIRoof
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $ ,/3� QC)Q. �i c7 UtilitieslnSewer Septic Building Height:
LJ Shutters
Windows/Doors
Roof pitch
�
QO.NEtJLESS1
CONTRACTOR
,� ..
Name E. C O
Name: Q OA �. f
Address: � 7� `l L-1 L 'VM
Company-7-R,1�n 4
}t�,f
City. uC Lu E V L . State: Fl.
Address: s��SD S�
C_ta 0.j
Zip Code3L-)G -, Fax: t3 � a4
City: kr I- S�-. )-U 0- uL_
J State:* -
Phone No. :ta , 0)
Zip Code:,'Pq 9 5 ,4,
Fax: _01 �4
E-Mail:AJ -
Phone No. `1 `1 a._ 3\07s-
fKJO) �S�J'
./.A
Fill in fee simple Title Holder on next page (if different
E-Mail:
.GUI
State or County License: }
from the Owner listed above)
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: _X_ Not Ap
Name:_
Address:
City: _
Zip:
Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:_
State:
Not Applicable
MORTGAGE COMPANY: A Not Applicable
Name:
Address:
City: State: _
Zip: Phone:
BONDING COMPANY: )LNot 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 Floridi a 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 our Notice of Commencement.
Sigriature of Owner/ Lessee/Contractor as Agent for Owner
Sig ture of Contractor/License Holder
STATE OF FLORITU°►
LIJC
STATE OF FLORIDA �n f
COUNTY OF
COUNTY OF J. IR,
The forgoing instrument was acknowledged before me
this=U of ��� 20� by
The forgoing instrument was acknowledged before me
this day day of ���, 21n/ by
,day
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
(Signature of Notary Public- Sta f Iorida KKENNY
(Sign ure of Notary Public- State of orida )
�� : • ••. k•
Commission No. + * Cofn%qon # GG 144499
.. sky ? MARK KENNY
Commission No. Co( n#GG144499
1woe Expires September 19, 2021
FOFF��� BoodedThmSudgetNotwyServioes
w Expires September 19, 2021
s
oQ° BmWTtruBudgetrklatyWAMa
OF F�
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17