HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE I FO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: rJ �' ci
= � RECEIV-ED NOV 10 1015
M0.14. -
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: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: ' Al\J
Legal Description: ���_0 101)'lr'� at- , �On /D �lY ca)� ,_�(� —f /023f
oAiYVL' Ac�r'1i1�nQ/4 O Stf.i� Cl t� 1
Property Tax ID#: Lk!� a�h�1 I —���i Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
1.00 + r 1r�Gz u) 'l i� �t 0—
CONSTRUCTION INFORMATION:
Additional work to be nertormed under this permit-check all appy:
HVAC Gas Tank Gas Piping _Shutters Q Wi dows/Doors
Electric ❑ Plumbing Sprinklers M Generator _r2 Roof
Total Sq. Ft of Construction: <j_ Sq. Ft.of First Floor: gog
Cost of Construction:$ C)-L-) Utilities: Sewer OSeptic Building Height:
OWNER/ ESSEE: CONTRACTOR:
NameName: Jamie Cisco
Address:r(4,b_Ta2pl Avg Company: Sunshine Roofing, LLC
City: Yl State: Address: PO Box 1083
Zip Code: I Fa City: Palm City State:FL
Phone No-:239 --I'1 - 'ISS 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:
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 financin&consult with lender or an attorney before
commencing work or recording our Notice of Commence,,me•t.
Signatu :o Owner/Agent/Le ee Signaty e7of Contractor icense Holder
STAT
COUNTY OF OTa (� COUNTY OF O 1(r r-t'I'Y1
The ,,going instrument was acknowledged before me The fpjing instrument was acknowledged before me
this day of Wnv_0_ru jy� r 20�by thisday of AJ�y��.�it r 20_0'by
Jamie Cisco
(Nam of person cknowledging) (Name of person acknowledging)
(What of iVotary Pu ' - ate of ItIorida) ( nature Notary Pubtic- tate of Florida)
Personally Known OR Produced Identification X Personally Known X OR Produced Identification
Type of Identification Produced License Type of Identification Produced
Commission No. FF11908 (Seal) Commission No. FF119908 (Seal)
Revised 07/15/2014
REVIEWS FRONT -'ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS