HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATI INTO BE ACCEPTED
Date: Permit Number: I O
Building Permit Application SCANNED RECEIVED
Planning and Development Services BY
Building and Code Regulation Division St. Lucie COunt�PEB 1;. 2019
2300VirginiaAvenue,-Fort Pierce FL-34982- F ittingDepanment
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential Wt. Lucia r^unty
PERMIT APPLICATION FOR: Roof III
PROPOSED IMPROVEMENT LOCATION: III
Address:
Legal Description: ICiuPr VarIt-
Property Tax ID #: _�4 19 - 54D- 0078 - OD CI - 1 Lot No.2_
Site Plan Name: /1 Block No. yS
Project Name: gC1Y\cV1e7-
2Zif(,�?nf2
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
ae,roof er\tl (f, "off'
inSiull Ze90, SV 1-6mp +�tll pY�el
Pojgo,ss (b00% U�det�l�wte w F T� -
CONSTRUCTION INFORMATION
HaamonaiworKiooe errormea unaerimsperma-cneCKau apply:
E1HVAC Gas Tank 11GasPiping _Shutters ❑Windows/Doors
Electric 0 Plumbing Sprinklers Generator IF-71� Roof Roof pitch
Total Sq. Ft of Construction: i 17_ 111 Snf;-L S Ft. of First Floor: t n
Cost of Construction: $ 11160t).00 Utilities:llSewer EISeptic Building Height: Ip
OWNER/LESSEE:
CONTRACTOR:
Name�`eStL� ,94v,lhe7-
Name:.
Company: imonAefri (1.0()Wijnl1-Ln
�kc LL
Address: 10(o2 SA) 17e1 T-ic) G)Vd
City: �ork5+. L_uGi¢. Stater
Zip Code: � q S-3 Fax:
Phone No.I10Ii 14 Q2- --U65-Ll
Address: 1Ifj' ,Sr DnmiMrA 1te-..
City: 54-ya v-1'
Zip Code: 3Qgrf7
Phone No. 1772-i 61)D -
State: GL.
Fax:
18 7Z
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail- `i
State or County License:
%S .
\EIQ i
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: Not Appli le
Name:
_
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HO ER: _ Not Applicable
BONDING COMPANY Not Applicable
Name:
Name:
Address: /
Address:
City: !
City:
Zip: Phone:
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 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 bylaws that
rules, or and covenants may restrict or prohibit such
structure. 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.
The 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
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in your paying twice for
improvements to your property. A Notice of Commencement must be recorded and posted on the jobsite
before 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 Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORID) , � ,.,
STATE OF FL R
A _\
COUNTY OF MO(jLY�Sa�A 1
COUNTY OF
The for oing instrument. vas acknowledged before me
thi day of �OLI \ , 20 La by
The forgoing instrur�entt s acknowledge before me
this day oC�r" P , 20" by
_,14writ—orpecson making statement
onally Known OR Produced Identification
son making statement
Personal) Know OR Produced Identification
Typ
ntification
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17