HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: SCANWO Permit Number:
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Building Permit Applicatiopix
Planning and Development Services MAY 2 5 2918
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial WMgWa Department
PERMIT APPLICATION FOR: Roof
Address: 5 D C
Legal Description:
Property Tax ID #: C) �3� + D �- Q ) D
Site Plan Name:
Project Name: Kuuz Co, C d
Setbacks Front Back: Right Side: Left Side:
Lot No. o Jr e,1.
Block No.
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CQNSTRICTI{NINFORiUTATtQN sJ Y
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Additional work to be nerformed unfler
11HVAC
� ....
t is;permit - check
a
all
apply:
,-
Gas Tank
E]Gas Piping
_
Shutters
U Windows/Doors
11 Electric 0 Plumbing
Sprinklers
� Generator
� Roof Roof pitch
Total Sq. Ft of Construction: V a. q
S . Ft. of First Floor: N�
E]Septic
i4
Cost of Construction: $ D O L) 0 •
00 Utilities:Sewer
Building Height: _
�QNNER/LESSEE$
CONTRACTOR,
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Name
Name So�1 J 1 � �..G l S f a
sJinsc..&.
Company: :?kOL -
Address:al5SD SP. �i to m.tg�
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Address:50bJ Si,{1_bLQ$.O N-JL-.
City: V-, P),e ct State: FJ.
Zip Code:34941f Fax: 1J hq
City:�_ f+ u.
State:.
Phone No. I to - yL ?-i- %-1La H
Zip Code:3" q sa Fax: tJ
l-Io
E-Mail: k
Phone No. yi`l a. - o� Q% -' Ln
14
Fill in fee simple Title Holder on next page ( if different
E-Mail: VoUs,�l.r� ���,nSe.c,'111
6.a.�• Lo
from the Owner listed above)
State or County License:U.0—) -&2LI
D
If value of construction is $2500 or more, a. RECORDED Notice of Commencement is required.
�S;UE'PLEM NTALCC3I STRUCTIC}N�t,1 N` AWr)NFORMATh£7N
g
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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:
City:
Address:
City:
Zip: Phone:
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.
i
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 iCodes 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 your Notice of Commencement.
Sign ture of Owner/ Lessee/Contractor as Agent for Owner
Sig ture of Con trac or/License r
STATE OF FLORIDA p -
COUNTY L(,i,(',)
STATE OF FLORIDA � LLJ
OF �)�. �,
COUNTY OF �I O /L
The forgoing instrument was acknowledged before me i
The fo� ing instrument was acknowledged efore me
this / day ?7� 20 f ' by
this � day of 20� by
of
t,nJ ✓1 a. -
(&)A�) 'eli &R--')
o
Name of person making statement
Name of person making statement
Personally Known )4 OR Produced Identification
Personally Known �_ OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signat re of NotaryPublic- State of Flo r d )
(Signs re of Notary Public- State of Flo 'da
Commissio�lu• MARK Seal)
r�
Corr��'���Vo.Corrwnicsion#G144499 Seal)
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Expires September 19, 2021
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BaledilxuBudget Notary SeMw
REVIEWS
FRONT
ZONING
SUPERVISOR.
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIE
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
5/2
Rev.8/2/17