HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 5-31-2016 Permit Number:
RECEIVED
Building Permit Application MAY 3 1 2016
Planning and Development Services PEPruii i F fNG
Building and Code Regulation Division 5t. Lucie County, FL
2300 Virginia Avenue,Fort Pierce F134982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential x
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPRQVEIVIENT'LOCATION
Address: 8305 Coquina Ave
Legal Description: LAKEWOOD PARK-UNIT 8-BLK 91 LOT25(MAP 13/02N) (OR 1182-1845)
Property Tax ID#: 1301-608-0099-000-3 Lot No.
Site Plan Name: Lane Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK .
Tear off shingle roof install new shingle roof J1_/n kcor-
CONSTRUCTION INFORMATION
- .
Additionalwork toe e orme under t —checkispermit a appy:
HVAC 11 Gas Tank []Gas Piping _Shutters a Windows/Doors
11 Electric ❑ Plumbing Sprinklers ❑Generator Roof
Total Sq. Ft of Construction: 3500 Sq. Ft.of First Floor:
Cost of Construction:$ 11458.00 Utilities:0 Sewer W1Septic Building Height:
OWNER/,LESSEE ?CONTRACTOR: "
Name Delores Lane Name: Richie the roofer
Address:8305 Coquina Ave. Company:
City: Fort Pierce State:FL Address: 6704 Santa Clara Blvd
Zip Code: 34951 Fax: City: Fort Pierce State:FI
Phone No.772-201-3177 Zip Code: 34951 Fax:
E-Mail: Phone No. 772-473-6197
Fill in fee simple Title Holder on next page(if different E-Mail: dchieroofer@yahoo.com
from the Owner listed above) State or County License: 20506
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL,CQNSTR'UCTION LIEN.LAININFORMATION' "
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 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 Commencement.
s
_Signature of Owner/Lessee/Agent W ature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF _.:�% L' u -r COUNTY OF S A LCA
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of !'1'ta _� 20 f-.by this day of ( ti�I 20 by
-1 c�%�, nft", la„J L (-
(Name of person acknowledging) (Name of person acknowledging.4 A QQ
)
(Signat re of Notary Public-State of Florida} (Signature of Notaryublic-State of Florida) /
Personally Known OR Produced Identification Personally Known OR Produced Identification f
Type of Identification ProducedFt, D,L Type of Identification Produced
Commission No. (Seal) Commission No. (Seal)
KAREN S. NI LSEN
\1{111!
o5. NIELSEN
mmission# FF 115637
*` Commission# FF 115637
Revised 07/15/2014 -� MY Commission Expires ,
June 12, 2018 :q M Commission Expires
a Y P
iJune 1 2 2018
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