HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INF MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: a.��a,1 \� PermitNumber:owli
SCANNED
o ;0�0 BY
St. Lucie County
Building Permit ApplicationPlanning
aE
and Development ServicesBuilding
and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: Roof
PROQOSEd Ii P 07 EMENT LOGAiT�ION
Address: 2Co$1 _Ens i AVinlo7/��re1��etC"
Legal Description: \�r(l T �r:)C\' 5b " \ PY-A C IC
Property Tax ID#:_$ jL{%q-rr7 )t]Lot No. 2-
Site Plan Name: Block No. 2-
Project Name:
Setbacks Front Back: Right Side: Left Side:
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OHVAC
Gas Tank ❑Gas Piping _ Shutters Windows/Doors
Electric 0 Plumbing ❑Sprinklers ❑ Generator L Roof Roof pitch
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Total Sq. Ft of Construction: j� SiRH S Ft. of First Floor: 7� 2 SILI
Cost of Construction:$ 15r C utilities:nSewerOSeptic Building Height:
#�WNER'ifSSE
Name Name:
Address: a(&1 -7-1 �s�,'t,1 Ave- `% Company: L•PnIL
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City: r-Or k State: ! ( Address: ( I l I? c to
can r-
zip Code: _ 34q y(n Fax: City: h- e State:_
Phone No.a-421-1Q¢`L-1101-ICE Zip Code:_AIgRi Fax:_T32-?(_,(1-a?i3
E-Mail: Phone No. a') - &y
Fill in fee simple Title Holder on next page ( if different E-Mail:
from the Owner listed above) State or County License: C cc
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER:
_ Not Applicable
MORTGAGE COMPANY:
_ Not Applicable
Name:
Name:
Address:
Address:
City:
State:
City:
State:
Zip:
Phone:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Not Applicable
BONDING COMPANY:
_Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip:
Phone:
Zip: Phone:
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
�]- GOLo l&.t_ s
Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF S+ (��� L COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this It day of Ep_`s 20 ]_by this 1Z day of " , 20 1_&_ by
(Name of person acknowledging) (Name of person acknowledging )
,JJA4 0 1
(Signalof Notary ublic- State of Florida) (Signatur f Notary P blic- State of Florida )
Personally Known —$-- OR Produced Identification
Type of Identification Produced
Commission No.
Revised
SALLY PORTES
My Commission Expires
November 15. 2020
Personally Known x OR Produced Identification
Type of Identification Produced
Commission No.
SALLY
M. Commission Expire
Ncvembei 15. 202
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