HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL I APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Datl Permit Number:
P
u Idi er
ing and Developmen e
rig and Code.Regulation Division
Virginia Avenue, Fort Pierce FL 34982
e: (772) 462-1553 Fax: (772) 462-1578 COM
PER
�111T APPLICATION FOR: Roof 'NNED
.,PRO,,OS'ED
IMPROVEMENT LOCATION: "` T__ __.
Addres: Co (401 Cam i7/QYii 1 1G
Legal description: IJG,r>' i5h J G kp.0 1pGi4- tja C7C :S_� Ls�� a-4
Prope�y Tax ID #: 3 d �- Sd v ��,� a0 d Lot No. C�3
Site PI;'n Name: Block No. 53
Proje Name:
Setbacks Front Back: Right Side: Left Side:
DET ILED DESCRIPTION 'OF WORK:ke-
CON TRUCTION, INFORMATION:
Additi
EII
D'nal work to be ertormed
VAC Gas Tank
under this permit— check
❑Gas Piping
all
a p p y:
_ Shutters
a Windows/Doors
❑
lectric 0 Plumbing
Sprinklers
ElGenerator
g Roof S �d Roof pitch
Total
. Ft of Construction: 4
b� /�
S . Ft. of First Floor:
Cost o
Construction: $ % 10d O Utilities:
Sewer Septic
Building Height:
OW "
jER/LESSEE:
CONTRACTOR:
Name
Addre
City:
Zip Cc
Phone�10.
E-Mai
Fill in
from t
tW ✓ rin a
Name: r1C:� G
Company: TREASURE COAST ROOFIN
Address: 1816 SW BILTMORE STREET
City: 7 s C+ State: FL
Zip Code: 34984 Fax: 772-343-8358
Phone No. 772-370-9770
E-Mail: TCROOFINGLLC@GMAIL.COM
State or County License: CCC1330653
s:� 7�� 17GY1i !�G
_1_,6kW4 Dax State: IfG
e: G Fax:
7 �5/-. J�%�— S 9 9-k
fee simple Title Holder on next page ( if different
e Owner listed above)
If valuelpf construction is $2500 or more, a RECORDED Notice of Commencement is required.
SU0PLEMENTAL
CONSTRUCTION LIEN LAW INFORMATION:
DES
GNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: Not Applicable
Na
F:
_
Name:
Address:
Address:
State:
City
City: State:
Zip:
11
Phone
Zip: Phone:
FEE
SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Na
`e:
Name:
1816 SW BILTMORE STREET
Address:
Address:
City
City:
1
I Phone:
11
Zip: Phone:
Zip:
OWN
R/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certi
that no work or installation has commenced prior to the issuance of a permit.
St. Luc
County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which
struCtL
in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
e. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In con'deration
of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
in accq
dance 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,
access
ry structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
WAR
ING TO OWNER: Your failure to Record a Notice of Commencement may result in your paying twice for
impr9i
ements to your property. A Notice of Commencement must be recorded and posted on the jobsite
befor'
the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing
work or recording our Notice of Commencement.
Signature
of O e ee ont cto as Agent for Owner
Signature of Contractor/Lic rise olde
STAI
IE OF FLORIDA
STATE OF FLORIDA
COUI
TY OF STLCUIE
COUNTY OF STLUCIE
The f
this
oing instrument was acknowled before me
day o-Q�
2by
The f oing instrument was acknowledged before me
this day of 20Id by
_
,
BRIA4
MALONEY
BRIAN J MALONEY
Name of person makin tatement
Name of person making statement
Personally Known x ORP oduced Identification
Personally Known x OR duced Identification
Type of Identification-//
Type of Identification
Prodt ced
Produced
(Sign
I ture of N Pu Ic State of Florida)
(Signature of N Florida )
Com
fission N FF122434 a
ROBE
Commission N FF1 43,¢, `^'• �1KE
�o�ry public �
NotaryPublic—
ROSERT BRD222
of Florida
Comm,ggio� GG 17697
- : ' hIY Comm, Expires 2
MaY
6cnced :nro 12, 2022
REV
'..
Comm. Expires
EWS
F Ord ."'•''''
ZONIJ4QNa�onOR
PLANS
VEGETATION
SEA TURTLE
MA"ft OVE
C
REVIEW
REVIEW
REVIEW
REVIEW
DATE
174
RECEIVED
DATE
i0i
COM
LETED
- 9
Rev.8/'
17