HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONkLL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED qq
SCANNEDDate: BYPermit Number:
Sr. Lucie Count - - --
• RECEIVED
Building Permit Application JUN 2 8 2018
Planning and Development Services
Building and Code Regulation Division 5T. Lucie County, Per ting
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: Roof El I
PROPOSED IMPROVEMENT LOCATION:
it Description:
roperty Tax ID #: `�d ' ( (Z d 000 6
to Plan Name:
roject Name: `f ` oy' .
Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Lot No. k 32
Block No.
CONSTRUCTION INFORMATION:
Additional work to (e ne orme under this permit — check
L_ 11HVAC J Gas Tank Gas Piping
a
apply:
Shutters
Q Windows/Doors
_
E]Electric 0 Plumbing
Sprinklers
ElGenerator
_ Roof Roof pitch
TI tal Sq. Ft of Construction: 3 Z
�d�
S .
Ft. of First Floor:
Cost of Construction: $ SO 1 0( t °L
I
utilities:
Sewer Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
Name:
Company:
Address:
S-ec9%_ o ��� ►'�
qSl 0 U
Address: f; 0.3 -o r\;
Cilty: State-l:L
Zip Code: Fax: I C
Phone No. i `�5 "� `b `! 1
EI Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
City: `i e -o 6-e,5 J-,
Zip Code: -z1>2A 6 7
Phone No. � ^i
E-Mail: -__,p -S
Stater
Fax: -66C -) u d I
Q\6 9'03
. co
State or County License: D
y 3
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTIO LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: -,-=Xot Applicable
Name:
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: _Not Applicable
f Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
II certify that no work or installation has commenced prior to the issuance of a permit.
Sit. 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,
acccessory 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
c6.mmencing work or recording our Nggc f Commencement.
I
ignature of Owner/ Les a Contrac r as Agent for Owner
Signat,6-re of ractor icense Hold
STATE OF FLORIDA
COUNTY OF
STATE OF FLORIDA
COUNTY OF���
11 he forgoing instrument was acknowledged before me
�1
The forgoing instru ent was acknowledged before me
this 2�day ^"-- 20A & by
this day of �^a� 20 by
of
Name of person king statement
Name of peaking statement
rsor
Personally Known OR Produced Identification
Personally Known ✓ OR Produced Identification
Type of Identification
Type of Identification
Produced
i
Produced
Signature of Notary Public- tr6r f Floridahw PEREZ
(Signature of Notary Public- State OW MWPEIREZ
Commission No. *GG19745p
Commission No. '�A-0-vseaIjFA,i,e��i��
eo.rda.�.b,crr,b
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
"
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Re '. 8/2/17