HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONN
11 PPLIICCABLE INFOMUSTBE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: 1
y _,. RECEIVED
Building Permit Application SEP 14 2018
ST. Lucie Count P
Pldnning and Development Services y, ermitting
BuIx
r ding and Code Regulation Division
23 �D Virginia Avenue, Fort Pierce FL 34982
Ph ne: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PE
MIT APPLICATION FOR: Roof SCAN
PR O,POSED
INIPROVEMENT.LOCATION':
ass: ) W bO Hamm
Description: 141 0 El
{fork- Sckt Luc l E, Plovl-+A
�I a A LOT 6 2..'7 r7 AC 0C, 3�83-15Z
Prop'rty Tax ID #: �h 1 I ' n 11 ' U 0 U LO ' U UU ' `1 Lot No.
Site. Ilan Name: Block No.
I
Proje t Name:
Setb 'Ifcks Front Back: Right Side: Left Side:
DET ILED-,OESCRI,PTION:OF WORK:
W_C i2ioof-
CONSTRUCTION INFORMATION:
Add'RElectric
ona wor to e e orme un er t is permit— c ec a app w.HVAC-' Gas Tank Gas Piping Shutters QWindows/Doors
Plumbing []Sprinklers El Generator Z Roof ® Roof pitch
Tota I
Cost
1. Ft of Construction':r+ Hr706 S . Ft. of First Floor:
Construction: $ .37-600• 00 UtilitiesSewer ESeptic Building Height: _
OWNER/LESSEE:
(_S� sarc7lZE.
CONTRQGTOR: Q,DK{�o,o _
Name'L3ek
Addr
City:
City:
C
Phon
E-Ma
Fill in.
from
54e617-e-Y)bG
Name:06t LIhtn
Company: QDk�00�i�1' ��c-
Is: V7ZSD 'jAQVA A0 LA
A cjKV Lj t; State:FL
de: 39953 _ Fax:
NO.L..C-Ar
Address: � & � EVerG CA--
City: &4- 5434A4' LUO� e, State: FL
Zip Code: 3W983 Fax:
Phone No. (�%L�-SZ�"0113
E-Mail: QPiC oof-im • iAt,&I Ma l I -
f C/ O H
State or County License: CC ( 3 3 �'7 0- 1P
: Lr7�2(LYl �` GD1����'
ee simple Title Holder on next page (if different
t e Owner listed above)
If valuel'Jof construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL
I
CONSTRUCTION LIEN LAW INFORMATION:
DE IGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: Not Applicable
1
Name:
_
Name:
A61 ress:
Address:
CitI• State:
City: State:
Zip" Phone
Zip: 'Phone:
FE
SIMPLE TITLE HOLDER: Not Applicable
BONDING COMPANY: Not Applicable
i
Nape:
e:
Name:
Address:
Address:
Cit, is
City:
Phone:
Zip: Phone:
Zip
OW ER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I ce fy that no work or installation has commenced prior to the issuance of a permit.
St. Lu ie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
whic is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
strudj�ure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In coriIsideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
in ac ordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The f 'Illowing building permit applications are exempt from undergoing a full concurrency review: room additions,
acces gory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
WA KING TO OWNER: Your failure to Record a Notice of Commencement may result in your paying twice for
impr''', vements to your property. A Notice of Commencement must be recorded and posted on the jobsite
befo'1e the first inspection. I N ou intend to obtain financing, co It with lender or an attor y before
com ncin work or r or l our Notice of Commenceme
Sign
r e of Ow r/ Lessee/Contractor as Agent for Owner
tu
Signature of Contrac r/License Holder
ST
OF FLORIDA 1
S �
STATE OF FLORIDA1 //
U
CO1TE
NTY OF L L,
COUNTY OF J % /,
The
this
orgoing instrument was acknowledge before me
'� day of fi 20�'by
The forgoing instru . ent�as acknowledged efore me
this day of 20 r y
oe
Name of erson P akin statement
g
Pers Known OR Produced IdentificationZr
Name of person making statement
Personally Known OR Produced Identification
Wally
Typed of Identification
Type of Identification
Produced 0Produced
AA
i flu
(Sig
a�ure of Notary Public- State of Florida)
(Signature ic- State of Florida )
Commission
No. , �� ���� AgEfa IELSEN
Commissi _ AREN S.
`^ '
State of Florida -Notary Public
* •_ Commission # GG 207434
Corn r�aa'Notary p
��� mission # GG 20?r,4
r My Co av
i11� mmis
M Commission Ex i s
sio n :
June 12,
2022
07.2
RE
EWS
R
PLANS
VEGETATION
SE
ANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE,
RECE,
VIED,
DAT41
COMPLETED
a
Rev.8/
/17