HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: '
RECEI,'..D OCT 13 2017
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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: Roof
PROPOSED_-MPROVEMENT LOCATION: =
Address: I /2 1�dt�C WO0-1) A?l . -2: /:17z0gCiF . T�–
Legal Description: Estates of Longwood E 112 of Lot 9 and all Lot 10(0.53 AC)(OR 4048-1350)
Property Tax ID#: 2433-502-0010-000-0 Lot No.
Site Plan Name: Block No.
Project Name: 1812 Hazelwood-Reroof
Setbacks Front Back: Right Side: Left Side:
DETAILED-DESCRIPTION-OF WORK:
Reroof : Tear-off existing asphalt shingle roof and replace with new asphalt shingle roof
��ffN�GC.� �O 6NS%�LLLJ? cS�I�R Lgy( � Ole �}S%/r� ��2 !` X�'
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CONSTRUCTION INFORMATION: -
ACIClitional work to e—e orme under this permit–check a appy:
F]HVAC be
❑Gas Piping Shutters ❑Windows/Doors
Electric 0 Plumbing OSprinklers _ enerator
W1 Roof Roof pitch
Total Sq. Ft of Construction: 5600 S . Ft.of First Floor: 3313
Cost of Construction: $ 16,600.00 Utilities:n Sewer E]Septic Building Height: 13 ft
-OWNER/LESSEE: CONTRACTOR:
Name_ i rE abMicS 04 i fit IA90 ,W co *r Name: �JbR tv � ,2)&pnA o4
Address:/41 't/W F��r1 r9L J! W y Company: Durham Brothers, Inc.
City: -Tie -AAr State:FL Address: /` 71 hg J9
Zip Code:/ q al Fax: City:G JGGLN i 6'fV YV State:FL
Phone Nd Cf.W 304 3 7 J 'Y' Zip Code: 33414 Fax: (561)594-3547
E-Mail: Phone No. (561)315-1835
Fill in fee simple Title Holder on next page(if different E-Mail: johnfdurham@msn.com
from the Owner listed above) State or County License: CCC 1326757
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION,.-
DESIGNER/ENGINEER:
NFORMATION: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:
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.
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
commencing work or recording our Notice of Commencement.
Sig ure of- wner/Lessee/Contractor as Agent for Owner S" ature of Contractor/License Holder
STATE OF FLOR STATE OF FLORIDA
COUNTY OF �� �,�e;� 0 COUNTY OF G�rv�h�-�v►
Th forgg�o�ing instrument as acknowledged before me The forgoing instrument was acknowledged before me
thie,'?iay of 20'�-\ by this 11 day of fl 1B-✓ .20 C"� by
Name of peaking statement Name of person making statement
rso
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Signature Notary Public-State of Florida) (Signature of Notary Publi Mtn' f,Florida WHEW SNYDER
. ;_ MY COMMISSION#GG 058673
Commission No. �> Qal) PHYLLISH.RINELLI Co fission No. 9.-YER
li EX )January27,2021
sq. p.
MY COMMISSION#FF 9 258 .•`' Bonded Thru Notary Public Underwriters
a EXPIRES:August 14,2 18 --
!p"i4' Bonded Thru Notary Public Unde iters
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17