HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONE]
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APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
te: 9-18-18 Permit Num
SEP I S 2018
Building Permit Applicatio
PlanningandDevelo mentServices Department
P Permitting �
e ilding and Code Regulation Division �t Lucie Coumyo FL
2800 Virginia Avenue, Fort Pierce FL 34982
Pone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
P�RMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION: _ SCANNFn
Address: 12863 South Indian River Drive By
Lel Description:
4 37 41 from pt on w bank of indoor. w 940ft N or S dry of sec run Ouniy-
th 6way to a r/w
P
ierty Tax ID #:
Plan Name:
act Name: DeFerrai-Guest House
Sacks Front Back:
Right Side: Left Side:
DEjTAILED DESCRIPTION OF WORK:
Inst " Ilation of a 5v Crimp metal roofing system -Guest house
AftI the fact permit -see engineering information attached
Lot No.
Block No.
CONSTRUCTION INFORMATION:
Aqgjtional work to e nerformed under this permit — c ec a apply:
HVAC Gas Tank ❑Gas Piping Shutters Q Windows/Doors
FlElectric 0 Plumbing ❑ Sprinklers Q Generator Q Roof 4/12 Roof pitch
Total Sq. Ft of Construction: 1200 S . Ft. of First Floor:
Cos f �of Construction: $ 3000 Utilitiest] Sewer Septic Building Height:
OWNER/LESSEE:
CONTRACTOR: -
Na I
e Dave a erran
Name. icar O ara
South Indian River riveElite
ess:
Rooting SolutionsInc.
Company:
Add
BeachState:
City.,
81 LincolnAve.
Address:
Zip
_
Code: Fax:
City: State:
Ph2t
No. 772-201-9030
Zip Code: 34994 - - Fax:
Phone No.
E-Mail:
Fill it fee simple Title Holder on next page ( if different
E-Mail: office.e Iteroo ingso utlons(Lbgmal .com
fro I the Owner listed above)
State or County License: GUY 1330337
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW LNFORMATION;
DESIGNER/ENGINEER: _ Not Applicable
fame:
d d ress:
City: State:
Zip: Phone
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MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
�tE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
dddress:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
C ty:
Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I C 'y 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
str�cture. 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.
They 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
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WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in your paying twice for
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improvements to your property. A Notice of Commencement must be recorded and posted on the jobsite
be ore the first inspection. If you intend to obtain financing, consult with lender or an attorney before
roomenrAft wodKr recordine vour Notice of Commencement. /l s
i'
ure of Owner/ Lessee/Contractor as Agent for Owner
XS*nafure of Contractor/License Holder
SI
ATE OF FLORIDA
STATE OF FLORIDA
COUNTY
OF %j Rhn
COUNTY OF
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for oing instr lent was cknowledge before me
- day 20 by
The forgoing instru en was acknowledged before me
this day of t�-(n 20 jf by
t
of
-&
�1
Name of person making statement
Name of person making statement
PI
rsonally Known X OR Produced Identification
Personally Known )0 _ OR Produced Identification
T�pe
of Identification
Type of Identification
Produced
Produced
(S�gnature
of Notary Public- State of Florida)
(Signature of Notary Public- State of Florida )
CoII
mmission NTheresa Anne FaI98SI)
Commission No. (Seal)
o NOTARY PUBLIC
STATE OF FLORIDA
NplpRVq� Theresa Anne Fasano
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REVIEW
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REVIEW
D�TE
RECEIVED
DATE
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