HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INsFZO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED q
Date: '6 \ ` \ Permit Number: Da
e FREC:EIVED
Building Permit Applicatio2019Planning and Development Services
Building and Code Regulation Division y, Pormltting
2300 Virginia Avenue, Fort Pierce FL 34992
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERM IT APPLICATION FOR: Roof_ Y+1 �7l HIV IVCU
ei-�1 �1'IduS41 RY
Address: A_CDI Killer•
Legal Description:
Property Tax ID #: 6y- 3) 3 0 11 ^ a a O Lot No.I a I
Site Plan Name:
Project Name:
Setbacks Front Back:
DETAILED DESCRIPTION OF WORK:
Right Side: Left Side:
Block No.
/Ea/ 0re.Xi5}in9 rva% cxyl , inskgkk nz.� Sq
UYlC:2,r 1Q1� (y�,C,NF ,
CONSTRUCTION iNFORMATIONs
itiona wor to e e orme un ert ispermit—checka apply:
OHVAC 13 Gas Tank �GasPiping _Shutters ❑Windows/Doors
11 Electric ElPlumbing Sprinklers 11 Generator Roof id Roof pitch
Total Sq. Ft of Construction: ff 3
Cost of Construction: $ Q , � 10 d d
5 Ft. of First Floor: _
Utilities:12 Sewer []Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name 5i
_
Name: Y t Ci.-N
Address: �L 1Z1Ver gCLrhWt0C�k T.N.
Company: TREASURE COASTROOFING
City: ` w-4 ar uu State: FL
Zip Code: ` iq 4 `� Fax:
Phone No. SZS-- 513- d197
Address: 1816 SW BILTMORE STREET
City: 0 e State: FL
Zip Code: 34984 Fax: 772-343-8358
Phone No. 772-370-9770 - --
-E=Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail: TCROOFINGLLC@GMAIL.COM
State or County License: CCC1330663
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
Name:
_ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City:
Zip'. Phone
State:
City: State:
Zip: Phone:
FEE SIMPLE TITLEHOLDER:
Name:
_ Not Applicable
BONDING COMPANY: _Not Applicable
Name:
Address: 1816 SW BILTMORE STREET
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 rules, bylaws or and covenants that 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
commen 'n ork or recording our Notice of Commencement.
Signature of Owner/ L ee/Cop ra or as Agent for Owner
Sig ature o Contractor/ tense o er
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF 6T LCOIE
COUNTY OF STLUCIE
The forgoing instrumentVs s acknowledged before me
The forgoing instrument was acknowledged before me
this L day of /k/ 20� by
this / day of � 20_1_q by
BRIAN J MALONEY
BRIAN J MALONEY
Name of person making statement
Name of person making statement
Personally Known x OR Produced Identification
Personally Known x OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
Pro(ducedd
Notary Public- Florida
(Signature of Notary P Ic- State of Florida
(Signature of of )
Commission No. -2 y zq-'Z (Seal)
Commission No. oZ7V/zf-7 (Seal)
Public Stata of I:R
Inda
REVIEWS
FRONT
y4
wtor U I Ion GG 7
&M
4222
PLA
VEGETATION
S VI
� q!Flo
a l{}ipvE
COUNTER
REVIEW
WW, M
coftEWENPG 274
DATE- — —
a s
RECEIVED
DATE
COMPLETED
Rev.8/2/17