HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: YdDI 1 1 ,�I Permit Number:
•
Building Permit Application
RECEIVED
and Development Services NOV 12017
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 DD ���{�,t.ISI Department
Phone: (772)462-1553 Fax: (772)462-1578 Commercial R 911C11�91� g p
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at th6--end of line
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Address: Ln -ev"G
Legal Description: OCEAN RESORTS COOPERATIVE SITE 247(OR 1400-961)
Property Tax ID#: 1410-205-0247-000-6 Lot No.
Site.Plan Name: JAMES WOLTER Block No.
Project Name: REROOF
Setbacks Front Back: Right Side: Left Side:
TAILIQ DE5C�tl�'TION OF WORIC xg A £.
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TAKE EXISTING SHINGLE ROOF OFF AND REPLACE WITH NEW SHINGLE ROOF
CO�STRUCTJQN INFORMATIONfi
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Additional workto e e orme uridert ispermit—checka appy:
❑HVAC E]Gas Tank [:]Gas Piping in MGenerator
Shutters Windows/Doors
11 Electric 1:1Plumbing Sprinklers Roof X12 Roof pitch
Total Sq. Ft of Construction: I , ® L S S . Ft. of First Floor:
Cost of Construction:$ ( I 000 Utilities:cnSewer Septic Building Height:
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Name JAMES WOLTER Name: LEE DINENEERG
Address:818 DOUBLOON LANE 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.616-638-6341 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: 9reatroofsCfreedomroofers.corn
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.
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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 w or recording our Notice of Commencement.
d
gn ureof Owner Lessee/ ract as Agent for Owner ature of Contractor/Licens older
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF INDI (VER COUNTY OF INDIAN RIVER
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 25 day of OCTOBER 20J7 by this 25 day of OCTOBER 20_a by
LEE DINENBERG LEE DINENBERG —�
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
0"V_� �VO_21_cq LJ__
ea (2-A 94Z4 '
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Commission No. GG076355 ea ANNETTEMCGR Fl!ommi ion No. GG076355
ANNETTE MCGRORY
NotaryPubllc- f Florida
State t; v'Pu''
. • •= Commission 0 GG 76355 o ' e
• o`S M Comm.Expires Fe 23,2021 �o:_ NotaryPubllc—Sda
GG 076355
oEF .• Bonded through Nationi iiNotary Assn. 9► oe:` My Coi nm.Expires Feb 23,2021
REVIEWS FRONT ZO P ANS VEGETATION SE2`f1TL�nded hI �
COUNTER REVIEW REVIEW REVIEW REVIEW
—TryTEW —REVIEW—
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17