HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APP
IC jABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
1
Date:
l 2 2 Permit Number: l J ll(A
SCANNED
BY
e.
�i�.1�.9cia, G�.arffi, RECEIVED
. ..
Building Permit Application
Plannin
LAUG
and Development Services 0 3 2018
BuildingI
and Code Regulation Division
l& �c'�ntY,
2300 vi►
inia Avenue, Fort Pierce FL 34982 Fermittinr,
"=
Phone:
(772) 462-1553 Fax: (772) 462-1578 Commercial Resideniiiaf
PERIVII
APPLICATION FOR: Roof'
PR(7PQSD
IIVIP,R3VEMENTLOCATIQ`I qa
� 3 ar 5�"'• �ioY� f�tY
Address:
1C
(SsV - S- 84 fG 2 16 ISO �� O �0�.3�
Legal Del
cription: Tyn c c,n 11� mtv 1�-�S - tA,S. O
1 a�l
Propert
Tax ID #: 3'A02 "(601b- 0060 -' Lao " Z. Lot No.
Site Plan
Name: Block No.
nn
t4t0 i =t+n Cc
Project
ame: 0 re {L,r S
Front Back Right Side Left Side
Setback)
DTAfLE:®DESCRIPION
OFWORK �Wrul
rlS4la er �a r rrte`i i� ��-� l % CVCCeS o v r Afe ll
and
rt/l� �� l PG n -e is
4
�'� �'
wCQ{N'SRUCTIpNINFO'tIVII�TI01�
k.s. x�h`f
� �
r Ytt �(�� f � <�'a�ihivnx 0' T 3 wawn zY I „mFx i H',. «, =•9 aM
.
itio
�H
er orme under this permit - c ec a" apply:
, awor to eE]Gas
AC Tank ❑Gas Piping _ Shutters ❑ Windows/Doors
El
ctric 0 Plumbing []Sprinklers Generator Roof 5 12 Roof pitch
Total Sq
Ft of Construction: 32600 Sq.of First Floor:
lonstruction: OSeptic
Cost of
$ A (-3, 000• 0 0 Utilities: 11 Sewer Building Height:
01111NR/LES„.S.
+#$ ..{N� k"4��:.j �'..; 9k"Y de v h1E.
a H CO TRACTOR
h yy a �.. ,
'A v�'
..; 1''e
Name
O Name: i Z
Address,:
/� ,c
-Rio 3 /Zow-ayd S4-. Company: �o�I fzyo the SNs ► .s S►�e�k�
City: Ilr
1 &YGC. State: EL Address: O G l lu 1 i Tt Y�ra C
Zip Coc(:
3 Aq Rom_ Fax: City: ;' '4 e r f Stater
Phone t
o. -77 2' %2 - Q O 30 Zip Code: 340tl l Fax:
E-Mail:
v 1 rovC n S s4ris • rlv-11 Phone No. 77 2- 87 2- 00 3a
Fill in f
g
simple Title Holder on next page ( if different E-Mail: Sam lktraQ +04IrooPin_ a ws-�c+ns • r7 e '--
from th
Owner listed above) State or County License: o V. 4
C 3 7
If value
I.
f construction is $2500 or more, a RECORDED Notice of Commencement is required.
r
d
S,UppLEAIY��NTALCON5TRUTION
m� a
G,
L ENLAW INFER
a''..i„,a O,'u ... f. ma�:.w, a...... m 7 .:_ae "«.w�.
a "aw
TlflNa�
;. 'S ? 4a45n��
MORTGAGE COMPANY: _ Not Applicable
DESIG
ER/ENGINEER: _ Not Applicable
Name
Name:
Address:
Address:
City:
Zip:
( State:
f Phone
City: Stater
Zip: Phone:
FEE SIMPLE
TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name
Name:
s:
Addre
Address:
City:
Zip:
City:
I Phone:
I
Zip: Phone:
OWNE�,'/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify t at no work or installation has commenced prior to the issuance of a permit.
St. Lucie �ounty 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
structure1Please consult with your Home Owners Association and review your deed for any restrictions which may apply. ..
ration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
ince with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
ling building permit applications are exempt from undergoing a full concurrency review: room additions,
structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
JIG TO OWNER: Your failure to Record a Notice of Commencement may result in your paying twice for
ments to your property. A Notice of Commencement must be recorded and posted on the jobsite
he first inspection. If you intend to obtain financing, consult with lender or an attorney before
irino Wnrk nr rpre)pprinp vnur Nntire of Commencement. /I
Signat
a Owner/ Lessee/Coritr or as A or kw
ontractor/Licens:��e
S=ATEOF
T
OF FLORI
LORID rn
COUN
OF M
COUNTY OF
The for
cling instrument was acknowledged efore me
The forgoing instruJ� ent was acknowledgedPefore me
` li TlsG�tfS'�C 20 t by
this
day of 4, 20 iyby
this --day of ,
tX,� l-.�2
.3ua,'_ M.eZ
Perso
Name of perso making statement
Ily Known � OR Produced Identification
Name of pe so making statement
Personally Known ' OR Produced Identification
Type o
Identificatio
Type of Identificatio
Produced
I
Produced
(SiWureota
bli - Sta a of Florida)
(Signature of Notary ub ' -S e o riCo
THERESAJAFFE Seal)
Com is THEaESAJAFFE SealN
lorlda
Commissionq GG 202301'
?; o ary u c a e of Florida
Commission k GG 202301
M y Comm.mm. Expires Apr 1, 2022
of ,•• My Comm. Expires Apr 1, 2022
REVI
ZONING
SUPERVISOR
PLANS
SEA TURTLE
MANGROVE
WS
FRONT
VEGETATION
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEI,
ED
DATE
ri
� I
COMP
ETED
Rev. MY17