HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 12-9-2016 Permit Number:
s
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 x
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: 5610 Ft Pierce Blvd
Legal Description: LAKEWOOD PARK -UNIT 4- BLK 35 LOT5 (MAP 13/11 N) (OR 3090-998)
Property Tax ID #: 1301-604-0155-0100-2
Lot No.
Site Plan Name: !" d i1
Block No.
Project Name:
Setbacks Front Back: Right Side:
Left Side:
7DETAILED DESCRIPTION OF WORK:
Tear off existing shingle roof install a 30# underlayment and shingle roof.
Owens Corning FI 10674-R12 on a 5112 roof pitch
CONSTRUCTION INFORMATION.
Acid itiona I work to a er orme under this permit— check
I, E]Gas
a apply:
[] Windows/Doors
IJHVAC Gas Tank Piping
_ Shutters
11 Electric Q Plumbing O Sprinklers
GeneratorLr J Roof
Total Sq. Ft of Construction: 3200
S Ft. of First Floor:
1111Septic 9'
Cost of Construction: $ 9655.00 Utilities:
Sewer Building Height:
OWN ER/LESSEE:
CONTRACTOR;
Name John Hixson
Name: Richard A. Newland
Address: 5610 Fort Pierce Blvd. Fort Pierce, FL 34951
Company: Richie the Roofer
City: Fort Pierce, State: FL
Address: 6704 Santa Clara Blvd
City: Fort Pierce State: FL
Zip Code: 34951 Fax:
Phone No. 772-359-2686
Zip Code: 34951 Fax: 866-610-8652
E -Mail:
Phone No. 772164-4329
Fill in fee simple Title Holder on next page ( if different
E -Mail: richieroofer@yahoo.com
State or County License: 20506
from the Owner listed above)
if value of construction is 525uu or more, a KtLUKutli tyoncr u1 %.o1u1uct1c.c111C11L _ I Cy.. — -
SlUPI LEMENTAL.o I`Rl1CTION UEr4 �INF RMAT ON... -
DESIGNER/ENGINEER: Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone:
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 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
commencinja work or recording your Notice of Commencement.
_ Signature of Owner/ Lessee/Agent
of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF % t` c f _ COUNTY OF
The forgoing instrument was acknowledged before me The f rgoing instr ent was acknowledged before me
this "5 day of P�L €-u cLr4 20 aby this day of _,20P by
rt a t� G2 �/
(Name of person acknowledging) (Name of per on acknowledging )
C
(Signatureof_,Notac; gblic- State of Florida )
own 611 Promo 'iaVL�
e o dentification Prod "°"s.. ie�I5TY60SILN
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' MAR 13, 2! 17
Commission No. 31stState 111smrtsa
Revised 07/15/2014
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(Signature of Notary Publ c State of Florida 5
Personal) I
e of Identification Prod
Commission No.
uced Identification
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f E.�'I`�AR 13, 2G17
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
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DATE
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INITIALS