HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ��//��
Date: 3/9/2017 Permit Number:z 70-;. V;a o
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Building Permit Application RECEIVED
Planning and Development Services MAR 10 2017
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: Roof El
PROpOSED IMPROVEME-NT LQCATION:.
Address: 4609 BUCHANAN DRIVE,FORT PIERCE,FL.34982
Legal Description: INDIAN RIVER STATES-UNIT4-BLOK 38,LOT 5
Property Tax ID#: 3402-605-0119-000-7 Lot No.5
Site Plan Name: Block No. 38
Project Name: R 2 0
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION
. OF.WORK
ASPHALT DIMENSIONAL SHINGLES TO ASPHALT 3-TAB SHINGLES RE-ROOF
CONS'TRUCTIO'N,INFORMATIQN. .
Additional work toe e Orme under this permit-c ec a appy:
❑HVAC 11 Gas Tank Gas Piping
i in _Shutters Windows Doors
1-1Electric0 Plumbing Sprinklers ❑Generator R Roof Roof pitch
Total Sq. Ft of Construction: 1400 SFt.of First Floor:
Cost of Construction:$ 4,200.00 Utilities:cnSewer❑Septic Building Height: 10,
OWN ER/LESSEE; „,CONTRACTOR:
Name -Rena . Name: PHILIP BLAKE
Address: 3/� f AV 00% ��' Company: BLAKE BUILDING CONSTRUCTION
City: �in� �di�1 �iC�x� State: t, Address: 16610 75TH NORTH PLACE
Zip Code: 3 yyr3 /Fax:
City: LOXAHOTCHEE State:FL
Phone No. I- / gyp—� � Zip Code: 33440 Fax:
E-Mail: Phone No. (561)281-5890
Fill in fee simple Title Holder on next page(if different E-Mail: BBCBLAKE@GMAIL.COM
from the Owner listed above) State or County License: CCC1327025
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SURPLEMENTAI_CO:NSTRUCTI(j`N LIEN LAIN fNFORMATION
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 ob financing, consult w' h lender or an attorney before
commencing work or r cordin our N of Commencement.
s
Signature of Owner/Lessee/Contractor as Agent for Owner Signat of Cont? ctor/License Holder
STATE OF FLORID STATE OF FLORIDA
COUNTY OF �h�./� c/1 COUNTY OF 'Rvn e)9_C_C. I/1
The for oing instru ent was acknowledged before me The forgoing instrument was acknowledged before me
this cl day of / 20 Eby this q day of r C h 20 by
mac Q& I'VI ��
(Name of person acknowledging) (Name of perso acknowledging-)
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(Signature of Notary PuGlic-State of Florida) (Sig ature of Nota ate of Florida)
Personally Known K� OR Produced Identification Personally Known /OR Produced Identification
Type of Identification Produced Type of Identification Produced
`��1111111111 I NPi/�y
Commission No. Commission No. F 216 (Seal) dOAR/
o�;..►,��yCHAND A. BLANFORD ���� P�, �SSIoN'
Commission N GG 62162 O mborg, /o•.
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Expires m ��,
Revised 07/15/2014 4y"�.P Jonuory i z, 2021 = •Sc a'
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DATE
COMPLETE
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