HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONr
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED t�
Date: Permit Number:
13Y _ RECEIVED
Building Permit Application HN 18 .,-18
Planning and Development Services
Building and Code Regulation Division S? i_ucie County, Permitting
2300 Virginia Avenue, Fort Pierce FL 34982 j
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential r%
PERMIT APPLICATION FOR: Roof.
PROPOSED IMPROVEMENT LOCATION:
Address:
Legal Description: 1- z_,1 . lkl�. �iaic l - (1 S- f4 J,)h 9 9 - t-
g 3 os C'_cv C
Property Tax ID #: � 1 I f� i • oC-)"�S - 0 co
Site Plan Name: E?
Project Name: L"K 0 UCj�
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
nev,nvoe ShurveS c0ncR replQcs w � Vrn�"
Lot No.
Block No. 8 g
CONSTRUCTION INFORMATION:
Additional work to e e orme under this permit - check a apply:
1JHVAC Ei Gas Tank Gas Piping _ Shutters Q Windows/Doors
Electric 0 Plumbing Sprinklers 11 Generator 0 Roof IT o11' Roof pitch
Total Sq. Ft of Construction: '005-J S . Ft. of First Floor: 1a 70
Cost of Construction: $ 1, ao�'�- Utilities: I_ISewer El Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name 7
Name: e
Address: 3051 COV7 i SZ Par
City: FUC�- rleA-C' Q Stater
S Zip Code: a4 f Fax:
Company:
Address: ( 7.1P -t`` W
City: �� QA I Stater
Phone No.
Zip Code: 3gg9 �7 Fax:39,q- 5111
E-Mail:
Phone No. 72-' -- G, OL.'>
Fill in fee simple Title Holder on next page (if different
E-Mail: Q 1
State or County License:
from the Owner listed above)
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required..
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
Name:
MORTGAGE COMPANY: &1*1N
Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: _Not Applicable
Name:
Address:
Address:
City:
Zip: Phone:
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 or an attorney before
commencing,wirFrk or recording your'Notice of Commencement.
c
�
Sign ure of Ow / Lessee/Contra as Agent for Owner
Sig ature of C actor/License I er
STATE OF FLO A
STATE OF FLORI jj
COUNTY OFF - L,(
�
COUNTY OF "Ll 1 0 I'Q
The forgoing instrument was acknowledged before me
The foj�r oing instru ent was acknowledged before me
this � day of 20 V$ by
this day of 20 (6by
P�1e�112fi�U4Arno
4
Name of pers n making statelment
Name df pers n making st ement
Personally Known _ Z OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Sig ature of No
(Si ure of
o ar;;� • Ic- a e o Florida
RYAN LYNN COLLUPY
RYA N LYNN COLLUPY
Commission No.
_ F I•'—AAY—COMMI���#FF170227
Commis on N
.`'i MY COMMISSIO(StW70227
-..",!�aF�,o„• EXPIRES October 21, 2018
'4 "o`. EXPIRES October 21, 2018
k.,,ofti}.•
407 398-0153 FloridallotaryService.com
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(d0Y-):98.0153 FlOridaNOtaryService.Com
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tev. 8/2/17