HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONPlanOing and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: ,AID 0���
RECEIVED
Building Permit Application
Permitting Department
St. Lucie County
Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
gal Description: �I 3�Qi 3 I 1 Rol K l arc
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'"Su-d'03 Dr wui rI -a-OR
Property Tax ID #: 31 3 — 000 t 60O Lot No.
Site Plan Name: Block No.
Project Name: c'ia�n
Setbacks Front Back: Right Side: Left Side: 13Y
DETAILED DE50RIPTIONOF WORk:
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01 f-c M 0 2-0-(�o -
CONSTRUCTION INFORMATION.:
Additional work to be nertormed under this permit— check a apply:
E1HVAC 0 Gas Tank Gas Piping _ Shutters ❑ Windows/Doors
❑ Electric ❑ Plumbing Sprinklers ❑ Generator ❑ Roof Roof pitch
TotaliSq. Ft of Construction: 0 S . Ft. of First Floor:
Cost of Construction: $ �L� o Utilities:cn Sewer O Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name, I ( 'r)r-��t t + i^ -II fied -Paik'
Name: OSI ��A�%Car?'
Address: (OOD6 hwq
C41�
Company: Ju yrm) ,%
City: 6"\R.(.(/1(7WL`e State:
Zip Code: 31407 Fax:
Phone No. IFL.P3— -N3 - !a U 7
Address: 16Q03
City: State:
Zip Code: 2 4 Q % (} Fax:
Phone No. ?�o?s
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail:
Stat County License: (C C r3,2 _
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
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'"1010812018 14:50 LUVIANO ROOFING
TAR)863 357 3566 P.0011001
PPLEMFNTAL CONSTRUCTION LIEN LAW INFORMATION:
ESIGNER ENGINEER: _ Not Applicable
ame:
ddress-
ity: State: f
p; Phone
SIMPLE TITLE HOLDER: _ Not Applicable
ame:
p; Fli
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City: State•
Zip: _ ; Phone:
BONDING COMPANY: —Not Applicable
Name;
Address:
City:-
Zip; . Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application Is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie Counttyy makes no representation that is granting a permit will authorize the permit holderto build the subject structure
which is in onflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Pease consult with your Home Owners Association and review your deed or 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.
following building permit applications are exempt from undergoing a full concurren review: room additions,
ssory structures, swimming pools, fences, walls, signs, screen rooms accessory us to another non-residential use
ANING TO OWNER: Your failure to Record a Notice of Co a cement ma suit in your paying twice for
Ir rmy� nits to roperty. A Notice of Commenceme m st be reco a and posted on the jobsite
o�he�ffirstX,tspect n. If you intend to obtain financing con ult with le de or rney before
e c a o k or r ordinE your Notice of Commence nt.
as Aaent for Owner
STATE OF FLORIDA
COUNTY OFF
TheirIng Instrument was acknowledged efore me
this , day o Oao ee i — 20 LY by
ISamOof persdhmaking statement
rsonally Known OR'Produced Identification
pa of identification
1 gnacure
Commissio
REVIEWS
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17
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STATE OF FLORIDA
COUNTY OF
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MARtiitdA 001i MARLINA GODINaz
A. MY COMMISSION p(ON14236 Commiss d pplggipN a GG{
EXPIRES June 13. 2021 EXPIRF-6 dune 13, 2021
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