HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 10/12/17 Permit Number:-n
R E C ER D OCT 13 2017
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
PR P9ED
: ..
r Address: 7408 Kenwood Road Fort Pierce, FI 34951
Legal Description: Lakewood Park Addition No 1-BLKC Lot 16(OR 2172-68)
Property Tax ID#: 1302-810-0067-000-4 Lot No. 16
Site Plan Name: N/A Block No. C
Project Name: N/a
Setbacks Front Back: Right Side: Left Side:
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Remove existing Shingle Roof down to wood deck, refasten wood deck to meet current Florida
Building Code requirements. Install one ply self adhering shingle underlayment adhered directly to
plywood deck. Install dimensional Shingles. Pitch 6/12 21 Squares
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Additional work toe e orme un er t is permit-c ec a appy:
❑HVAC E]Gas Tank ❑Gas Pig Shutters ❑_ Windows/Doors
11 Pin
Electric 0 Plumbing Sprinklers ❑Generator W1 Roof 6/12 Roof pitch
Total Sq. Ft of Construction: 2100 'Sq. Ft. of First Floor:
Cost of Construction:$ 10,321.00 Utilities: Sewer Septic Building Height:
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Name Kevin Carroll Name: William Lasky Jr
Address:7508 Kenwood Rd Company: Atlantic Roofing II of Vero Beach Inc.
City: Fort Pierce State:171 Address: 4020 43rd Ave
Zip Code: 34951 Fax: City: Vero Beach State:FI
Phone No.nla Zip Code: 32960 Fax: 772-257-5740
E-Mail:nla Phone No. 7702-492-8493
Fill in fee simple Title Holder on next page(if different E-Mail: wljatr@aol.com
from the Owner listed above) State or County License: CCC1326188
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER: X Not Applicable MORTGAGE COMPANY: Not Applicable
Name:_ Name
Address: Address:
City: Fort Pierce State: City: Vero Beach State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address:4020 43rd Ave Address:
City: City:
Zip: Phone: Zip: Phone:
OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
r 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,peFform 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 u intend to obtain financing, consult with lender or an ttorney before
commencingwork or recor in o r Notice of Commencement.
Signature of Owner/Les ee o r or as Agent for Owner trignature of Contracto icens older
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF Indian River COUNTY OF Indian River
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 12th day of October 20LIL by this 12 day of October 202 by
William Lasky Jr./Contractor as Agent for Owner William Lasky Jr.Contractor
Name of person making statement Name of person making statement
Personally Known x OR Produced Identification Personally Known x OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Signa re of Notary Public-State of (S nat a of Notary Public-S
<�:•, ;;:�:...... , DEBORAH L.AUSTIN
o;!"iN�G, DEBORAH L.AU ST N " FF 079676 '* *= sion#FF 079676
Commission No. FF 079676 =: Commission#FF 0mmission No. p riy�January 6,2018
Expires January 6,2)18 � ''`. r
F��. Bonded Thnt Troy Fan Insurance E00.765-70 9
,�, � Bonded Thru Troy Fan im P. 800.3854019
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17