HomeMy WebLinkAboutApplication for Roof Permit All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:T� 15 Permit Number: ISO 5.O a 11
41111110
RECEIVED MAY 0.11015
• r
- Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential L'/_
PERMIT APPLICATION FOR:
PROPMSED lNPRMUEMENT LOCATION:
Address: X111) ki)��a s efla .ter(" Z3 LI1 LES-
Legal Description: 4=&!Z CweT-5 ES6/kl�S CAX 'C, (,DE AC I -D 4��(ae_izil —! �
Property Tax ID#: a3 a3 30 I cab 3q 000 Z Lot No.
Site Plan Name: _ Block No.
Project Name: V45 mX""C-E
Setbacks Front Back: Right Side: Left Side:
DETAILED DE�SCRIPTIONOF WORK:
Ze�hbu- Ady7 Q AtA �ftArrvLteS 6.N R A-e L /5E Qzmp E ONL.y
CMNSTRUCTIM INFORMATION:
Additional worK to be pertormed under this permit—check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric _Plumbing �f Sprinklers _Generator Roof
Total Sq. Ft of Construction: �` —1-'r�" Sq. Ft.of First Floor:
Cost of Construction: $_ � Utilities: _Sewer _Septic Building Height:
MINNER/LE�StiSEE: CO ^TRACTOR:
Name Dlk0 y 0-6e ol, L,t NaclllkS�orSFsl
Address: "? D •� i .
�� 4��� M�S �� Company: .Or erf'�s�aNC�c,.v-�v►
City: PL,r2V Stater Address: ?;SI L 6LF-AN2V0e�
Zip CodeFax: City
�� ,� ��� State:_f_('
Phone No. Ut Z4A Zip Code:-3&9?/ r6kt q' 01—ca(C-5
E-Mail: Phone No ( L(a —
Fill in fee simple Title Holder on next page (if different E-Mail
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SCIPPLEMkNT�A1.C®NSTft'tJCTION 1.1EN LAW I'N•F®RMATION:
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:
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.
Inconsideration of the granting of this requested'permit, I do he 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.con.currency,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 an ted on the jobsite
before the first ins tion. If you intend to obtain financing, consult with le or an attorney before
commencing wpfkGr/Te!bording your Notice of Commencement.
i
Signature of essee/Agent Signature of Contractor Livens er
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF S�- . L�c �� COUNTY OF S�'. L 4�
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this N_day of 20_A 5 by this\day of Mcs\,-420�AS by
S�eJ� � CAS�OM �O°�y SAn, n- C-,S dv,. Ua
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Pubic`State of Florida) (Signature of Notary P lic-State of Florida )
Personally Known OR Produced Ide ion Personally Known OR Produced Identification
Type of Identification OPG0IENo,V31\6a6 Type of Identification -;
Produced c L ur,—N. skskt I7.t1 Produced
*
Nota`! EXP EE 95 ASsa.
missiNo. -TA-W"' (:Com .
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- My�` o EE 858761
Bonaed fou
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DATE
RECEIVED
DATE
COMPLETED
Te—v.7/2014