HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ll�
Date: 5/15/17 Permit Number: 1 �D�'�I70
• A 19
_ _
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: 5276 GALLEY WAY, FT. PIERCE FL 34949
Legal Description: OCEAN RESORTS COOPERATIVE SITE 109(OR 3754-2846)
Property Tax ID#: 1410-502-0109-000-7 Lot No.
Site Plan Name: WILLIAM&REBEKAH THOMPSON Block No.
Project Name: REROOF
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
REMOVE EXISTING ROOF AND REPLACE WITH NEW SHINGLE ROOF
CONSTRUCTION INFORMATION:
i
Additional work toe e orme Is un under t permit—check a appy:
HVAC E]Gas Tank ❑Gas Piping _Shutters Q Windows/Doors
Electric Plumbing Sprinklers I Generator FS/1 Roof /Z CRoof pitch
Total Sq. Ft of Construction: 850 SFt. of First Floor:
Cost of Construction:$ 3,800.00 Utilities:cnSewer Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
NameREBEKAH&WILLIAM THOMPSON Name: LEE DINENBERG
Address:5276 GALLEY WAY Company: FREEDOM ROOFERS
City: FT. PIERCE State:FL Address: 5575 US HWY 1 SUITES 1 &2
Zip Code: 34949 Fax: City: VERO BEACH State:FL
Phone No. Zip Code: 32967 Fax: 772-217-4459
E-Mail: Phone No. 772-318-4600
Fill in fee simple Title Holder on next page(if different E-Mail: lee@freedomroofers.com
from the Owner listed above) State or County License: CCC1330900
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 financing, consult with lender or an attorney before
commencin wo ' r recording our Notice of Commencement.
s
SiCnpfure of Owner/Lessee/ ontractor as Age ior Owner Signaulfe cif-Contrac ot`/License Holder
STATE OF FLORIDA XC i� STATE OF FLORIDA—�— f
COUNTY OF V�-Y COUNTY OF I IV��
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this�day of 20 aby this1 day of 20 T by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-State of Florida) (Signature of Notary Puubblic- ate of Florida)
Personally Known V/OR Produced Identification Personally Known / OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. N Sion 1'1 '
ANNETTE MCGRC RY ,�1PA�Pf •.; ANNETTE MCGRORY
_�•� �_ Notary Public-Stateo Florida :; ��: NotaryPubllc-State of Flo
t
:�. n
oF F`aPa'' My Comm.Expires Feb 23,2021 '•�S,•� �eP=` My Comm.Expires Feb 23,20!"oFF�" Bondedthrou
Revised 07/15/2014 BondedthroughNalionalNotaryAssn. gh National NolaryAs
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS