HomeMy WebLinkAboutBUILDING PERMIT APPLICATION -ROOFAll APPLICABLE INFO MUST BE COMPLETEv rOR APPLICATION TO BE ACCEPTED
Date: 7 —� 0 `/ / Permit Number:
RECEIVED
- --- - Building Permit Application MAY 10 1019
Planning and Development Services SCANNED Permitting Department
St. Lucie County
Building and Code Regulation Division 1 BY
2300 Virginia Avenue, Fort Pierce FL 34982 St, ude CoUllty
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential 1�
PERMIT TYPE:
PROPOSED IMPROVEMENT LOCATION:
Address: Y916 0,e apt ct 4Rhe r—erT-,9,'er(e . l=L, 3 22t :R
Property Tax ID #: / 1130 .. 70 a - 00 / -7 — D O o/ Lot No. /
Site Plan Name: Block No. 3
Project Name:
Additional work to be performed under this permit- check all that apply:
—Mechanical — Gas Tank _ Gas Piping _ Shutters —Windows/Doors
— Electric _ Plumbing — Sprinklers _ Generator /Roof 41 1A Pitch
Total Sq. Ft of Construction: % 3 9",11 Sq. Ft. of First Floor: � 3 6
Cost of Construction: $ o� 3 CV Utilities: Sewer Septic Building Height: '0 �r
OWNER/LESSEE:
CONTRACTOR:
Name Xe-// Se r Q r' r1 i
Name:
Address: IV $ Li 7 .y 0-1 V ' TZ `
.. =s
'Company: _..
City: f=O/ % /� i C7� L2 iSYaYi>;o �::'-i:A'ddress9
Zip Code: 3 9 Fax: is ,, ,.F,•
Phone No. 7% 3 q 7— d 3 6
' a^' `J?,
,,.City,:• :.,.„" :•i `': fF State:_
Zip Code `'Y f Fax:
Phone No
E-Mail: KL/Z y <e RCL F I'nf' 40 �/C1l O, COvfj
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail
State or County License
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTrA' CONSTRUCTION LIEN LAW IN4RMA 10
DESIGNER/ENGINEER: _ Not Applicable I MORTGAGE COMPANY: !/Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: a/Not Applicable BONDING COMPANY: Not Applicable
Name:' Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
OWNER/ CONTRACT OK AFFIUVI 1: 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 Count makkes no, representation that is granting a permit will authorize the permit holderto build the subject structure
which is in conflictjviith any applicable Home Owners Association rules, bylaws.or.and covenants that -may restrict,or prohibit such
structure. Please consult with your Home Owners Association bnd 'review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit; I do hereby agree than -will, in all respects, perfo�ri 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 JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR CENDEWOR AN+ATTORNEY' BEFORE,RIiCORDING'YOUR NOTICE OF COMMENCEMENT.
Signature Owner/ Lessa /Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY
/-1/c, C
COUNTY OF
OF ,
The forgoing instrument was acknowledged before me
The forgoing instrument w acknowledg d efore me
this _ day of 20_ by
this' ���.iJay of 20 by
/10
/lam-;
¢�-� i S46/? / F: /tu
Name of person making statement.
�'
Name of per on making statement. -
_ `.
✓
Personally Known OR Produced Identification
Personally,Known OR Produced Identification
Type of Identification Produced--
Type of'Identification
J \ '
Produced
(Signature of Notary. Public- State of'Florida ),
fission - % `• -°.> (Seal)
(Signature of Nota blic-Sta of Flor
KIM
\,
Commission No.
zP�
= MY COMM
EXPIRES:
ICN R GG 093991 , \ \ `,
13,2021
'Bond�Gfku
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Rev 2/7/19