HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE I FO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED j�
Date: Permit Number: �� V' as�v
RECEIVED
Building::Permit Application q
Planning and Development Services OCT 2 3 200
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: 6-1. Lurle - a5c 341=
Legal Description - d' 0 a- - 1 L,.nZ
PropertyTax ID#: �iy'�`) _� -(��� �� ,�- S Lot No.
Site Plan Name: Block No.
Project Name: ;5r),b /Y-
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
,tyi�v W i5Q TO-0 (�.Q�Ci'.CQ- (.0 V -w
1-CONSTRUCTION INFORMATION:
Additional work to flGasTank
orme un ert ispermit-c ec a appy:
HVAC ❑Gas Piping _Shutters ❑Windows/Doors
11Electric 1:1 Plumbing Sprinklers Generator !9_Roof
Total Sq. Ft of Construction: S . Ft.of First Floor:
Cost of Construction:$10,(�(� Utilities:cnSewer D Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name :I-1Yn0L - C p' Name: Jamie Cisco
Address:c2LL5 5 I a=4.,e Company: Sunshine Roofing, LLC
City: f- , - 1 ij LAA State: Address: PO Box 1083
Zip Code: L 5 Fax: City: Palm City State:FL
Phone No. ��c�� /g�j _ ��.)�� Zip Code: 34991 Fax:
E-Mail: — Phone No. 772-260-8195
Fill in fee simple Title Holder on next page(if different E-Mail: sunshineroofingllc@gmail.com
from the Owner listed above) State or County License: CCC1327796
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGN /ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: 1 Name:
Address: R �r2 S Address:
City:�k } U-L C._ State:� City: State:
Zip: Phone: -1-7,)-74 SZ`d<,R 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 thepermit 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
commencing work or recording our Notice of Comm enceme t.
�—
ture of Owner/ ent/Lessee Signatuf,�q Contractor/License Holder
STATE OF FLORI STATE OF FLORIN
COUNTY OF M{ ,�,c COUNTY OF Y ✓�
The for Ding instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of �o��gq2�� 20 by this C�day of 20 by
ITf r4 Jamie Cisco
(Name of person acknowledging) (Name of person acknowledging)
/1, L-1 Ai - rR"�_ 0A/I--* Ae,7,
gnature o otary ftrb46-§t61e of Florida) (Sign ure of otary Pu " -State of Florida)
Personally Known OR Produced Identification X Personally Known x OR Produced Identification
Type of Identification Produced License f Identification ProduQQc
\Muni h5 o,NrP '�•• �
FF11908 �4PP�PLB� I1 ALYSS HAMPTON FF119908 '��p `e• LYSS HAMPTON
Commission No. . :alotary Public.State of Flfw ission No. �c¢
• � `�'�•.°• Nbt� ublic•State of Florida
• ;o,° My Comm.Expires Jul 1 ,2018 ;�? My Comm.Expires Jul 18,201
I p,. FF 119908
•�1 /1111\0,, FF 11 908 ,_11\\\
Revised 07/15/2014
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