HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 12-9-2016 Permit Number:
r
WIMI
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce Ft 34952
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 IMPROVEMENT LOCATION:
Address: 6705 DONLON RD
Legal Description: LAKEWOOD PARK -UNIT 11- BLK 137 LOTS 21 AND 22 (MAP 13/12N) (OR 1113-1379)
Property Tax ID #: 1301-613-0021-000-2
Site Plan Name:
Project Name:
Setbacks Front Back:
DETAILED DESCRIPTION OF WORK:
Right Side:
Left Side:
Tear off existing shingle roof install peel and stick Llnderlayment and shingle roof.
Oc Fl 10674-R12 Tri Built FI 16048-r3
Lot No._
Block No.
Additional work to be nertormed under this permit— cnecK an apply:
QHVAC 0 Gas Tank Gas Piping _ Shutters a Windows/Doors
DElectric 0 Plumbing 05prinklers Generator Roof
Total Sq. Ft of Construction: 2500 S Ft. of First Floor:
Cost of Construction: $ 8265.00 Utilities:Cn Sewer Septic Building Height: 91
OWNER/LESSEE:
CONTRACTOR:
Name Daniel K Clemons
Name. Richard A. Newland
Address: 6705 DONLON RD Fort Pierce, FL 34951
Company: Richie the Roofer
City: Fort Pierce, State: FL
Zip Code: 34951 Fax:
Phone No. 772 595 6645
Address: 6704 Santa Clara Blvd
City: Fort Pierce State: FL
Zip Code: 34951 Fax: 866-614-8652
Phone No. 772-464-4329
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E -Mail: richieroofer@yahoo.com
State or County License: 20506
If value of construction is $2500 or more, a RECORDED Notice of Commencement is requires.
SUPPLEMENTAL CONSTRUCTION LIEN LAIN INFORMATION:
DESIGNER/ENGINEER: Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: state:
Zip: Phone:
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
BONDING COMPANY: Not Applicable
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 Horne 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 your Notice of Commencement.
_ Signature of Owner/ Lessee/Agent 'Sig—nature of Contractor/License Holder
STATE OF FLO l_DA STATE OF FLORIDA
COUNTY OF / Z_t, c -Y COUNTY OF
Theforgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of .iCt h J,R ti r 20 _L7by this day of f�'r C, Y-71' , 20 by
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(Name of person acknowledging) (Name of person acknowledging)
2:2] 1 ire -`zTc? 1
(Signature of Notary Pdh_ric-_Sfate of Florida )
Commission No.
Revised 07/15/2014
ced Identification
{Signature of No a`t�lic- State of Florida j
F C0 KSS10N#EE883700 Commission No.
ES: h1AR 13,,
goaded i.`iqgi? 1st State Iasi rarrro
on
OR Produced Identification
141STY 80BILiN
My C0004 #EE883700
DTIR,LS: KLAN 13, 2047
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