HomeMy WebLinkAboutBuilding Permit ApplicationALL PPLICABLE INFO MUST BE COMPLETED FO APPLICATION TO E ACCEPTED
Date:
Permit Number:
Ming Permit Applicatio
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce Et 34982
Phone: (772} 462-1553 Fax: (772)462-1578 Commercial
PERMIT APPUCATION FOR: Roof
I"kbPOED ImPRCI)/0:48'NftINATION''
Address: 10725 S Ocean Dr Unit 337 Jensen Beach FL34957
Residential
egal Description: HOLIDAY OUT AT ST LUCIE BLK B LOT 27 AND EQUAL PRO -RATA INTEREST IN COMMON
ELEMENTS (OR 1938-506; 3691-2342; 3597-256; 3628-2068)
operty Tax iD 4511-501-0072-000-4
Site Plan Name.
Project Name:
Setbacks Front Back: Right Side: Left Slcle:
Lot No. 27
Block No, B
DETAILED DESCRIPTION OF WORK:
TEAR OFF EXISTING ROOF AND INSTALL NEW 30 YEAR ARCHITECTURAL SHINGLE ROOF
CONSTRUED° INFORMATION:
'---raCcITton-al work to be efflaTrned under thi—rnermit — check all flgt apply:
HVAC Gas Tank
0Electrc LiPlLirribing
"otal Sq. Ft of Construction: 824
-Ds( of Construction: $ 55975.00
OWNER/LESSEE:
Name David and Ramak Pogue
Address: 1083 Steeple Blvd
Gas Piping Shutter s
Sprinklers ril Generator
S. Ft. of First floor:
TA
Utilities: Sewer LSeptic
City: Brentwood
ZJp Code: 94513 Fax:
phone No, 925-605-8619
E -Mail:
Name: Ronald Latta
(Windows/Doors
Roof
Building Height:
Company: Treasure Coast Concepts Inc.
State: Ca. Address: 3458 SW Pluto St_
City: Port Saint Lucie
Zip Code; 34953
Phone No. 772-777-8130
State: FL
Fax: 772-995-4910
Fill in fee supple Title odder on neat page ( f cfifforeut E -Mail: tcconcepts@aol.com
from the ner listed above)
state or county License: CCC1330362
8 vakw of construction is $7500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: ____ Not Applicable
Name:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
BONDING COMPANY: _Not Applicable
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 ssuance 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, 1 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 winder or an attorney before
your 'i ice of Commencement. ,/
7thmjncingworkorre7y4iig
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Signature of Owner/ Lessee/Cori actor as Agent for Owner
STATE OF FLORIDASTATE
COUNTY OF
Sign ure df eantr or/Licen .H.plder
0 L _ i-7
r8RIDA_
COUNTY OF
The forgoing instrument was acknowledged before me
this day of 20 by
The foroing ins r en wa acknowIedgg
g
this !--?^A day of i i , 20 I )
before me
by
\c\ C
Name of person making statement
Personally Known OR Produced Identification
Name of person making statement 4 a
Personally Known OR Produced [dentfi
Type of Identification
Produced
Type of Identificatio
Produced
,
(r.L.1C C 04-kCk( \ry-c\
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(Signature of Notary Public- State of Florida )
Commission No. (Seal)
{Signature of Notary Pub c- State of Florida)
Commission No.i r:-,'::01-1 r (SeaI
j •.1 ,,
•
REVIEWS
FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR
REVIEW
PLANS
REVIEW
VEGETATION
REVIEW
SEA TURTLE
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17
CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT
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<.,•a•i_•..
A.• . . -
CML CODE § 1189
A notary public or other officer completing this certificate verifies only the identity of the individual who signed the
document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document.
State of California
County of ail r i (6,S 1
}
On /0 1H 4 \1 before me,7-)0,VV1 (71(XVIOICn !Jai'(Y.st) JP • , NL'4ki i );C C
Date Mere Insert Name and Title of the Officer
personally appeared DO 11) C PI yut,p
Namelifof SigneC(e
who proved to me on the basis of satisfactory evidence to be the personl,d' whose name( is/9e
subscribed to the within instrument and acknowledged to me that he/at-eft-hey executed the same in,
his/herftheir authorized capacity(iraer'and that by his/ferftheirsignature 'on the instrument the personX,
or the entity upon behalf of which the person( acted, executed the instrument.
OARRIN GEMDYA DUMAG JR
Notary Public • California
Contra Costa County n
Commission # 2174446
My Comm. Expires Dac 3, 2020
Place Notary Seal Above
certify under PENALTY OF PERJURY under the laws
of the State of California that the foregoing paragraph
is true and correct.
WITNESS my hand and official seal.
Signature
Signature of Notary Public
OPTIONAL
Though this section is optional, completing this information can deter alteration of the document or
fraudulent reattachment of this form to an unintended document.
Description of Attached Document
Tide or Type of Docump,nt: PAAt f,Nanf1r ii'1q�0-0103"\Document Date:
Number of Pages: a- Signers) Other Than Named Above:
Capacity(ies) Claimed by Signer(s)
Signer's Name: Signer's Name.
_ ❑ Corporate Officer — Title(s):
Partner — ❑I Limited ❑ General ■ - — ❑ Limited Ll General
❑ Individual L❑ Attorney in Fact IJ Individual ? . o!rney in Fact
LI Trustee ❑I Guardian or Conservator ❑ Trustee CI Guar
❑ Other: Ti Other:
Signer Is Representing: Signer Is Representing: --__
nservator
g••••.'v. M4'd4.L . e %C'NC A• 'S••,.,AC ' :M4:.d:6' • A:1.
02014 National Notary Association k www.NationalNotary.org 1 -800 -US NOTARY (1-800-876-6827) Item #5907