HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED U
Date: `�� �'� ` 1� Permit Number:
T. RECEIVEDqt Ligq
Building Permit Application JUN 18 2013
Planning and Development Services
Building and Code Regulation Division ST. Lucie County, Permitting
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential X
PERMIT APPLICATION FOR: Roof —
Address: U 1 V 1 ( 11 ru► �Wkn 1.1 I e.. )-b C-j- T-) A-t C I InU . Zi" 1 -1 173 I
Legal Description: Smyvn� S {� I cI 1C'l.�a S IJ4 D C to
e
Property Tax ID #: I3bU , 6"ia0 - IDa.tel l`AO - '-1 Lot No.lz�
Site Plan Name: Ca'M���n.11 �, Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
❑ HVAC
❑ Electric
Toad
Windows/Doors
❑ Plumbing Sprinklers ❑ Generator Roof Roof pitch
Total Sq. Ft of Construction: -D 6'A —7 S . Ft. of First Floor: // /119
Cost of Construction: $ / �;�0C) r)., U U Utilities:Cn Sewer ElSeptic Building Height:
OWNER/LESSEE
CONTRACTOR' m s
Name Ea 1 01 CA 4- 11,u
Name:
Address: f O
Company: D O-
City: �i-• G State:4A.
Address: a5:50 SIE. t^�LC-LLW c,
City:} , l cis State
Zip Code: q J 51 Fax: J
Phone No. 9 1 %- 34, S - 4,907
Zip Code: !:H 5 a Fax: >J 1-A
Phone No. 'l"� a, a��— %W 4%
E-Mail: tJ 124
Fill in fee simple Title Holder on next page ( if different
E-Mail: I U bi -111 )
from the Owner listed above)
State or County License: C�.C_ 13atr 11ite 0
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
Name:_
Address:
City: _
Zip:
EER: Not Appl
State:
Phone
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:.
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
�c Not Applicable
State:
Not Applicable
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 work or recording vour Notice of Commencement.
SigNature of Owner/ Lessee/Contractor as Agent for Owner
Sign ture of Contractor License Ho er
STATE OF FLO ADA3f—
STATE OY ), J
COUNTY OF LIJ eJ�
OUNTOF JJt L a G�
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged efore me
this day of --IV�� 201 ' by
this ) day of �T2 � 20Lby
Lac S �1r,r SAS.-ice.5�..�
(,� /i/I�.. L� s C �/A5 )e,,..SGy
Name of p son making statement
Name of person making statement
Personally Known �` OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
,,V_
T pe of Identification
Produced
wo /f
Produced
_/ /
(Signs re ofp9tary Public- State of Florida)
(Signat a of Notary Public- State of Florida )
ro ...,• MARK KENNY
MARK
Commission * C0mmission#GG1444g5eal
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Commissio�e o.- GG144499(Se
Na e� spires September 19, 2021
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a� Expirees September 19, 2021
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Rev. 8/2/17