HomeMy WebLinkAboutpermit application 4
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: �-7_ 141
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 IMPROVEMENT LOCATION:
Address: 8221 Maidencane Place Port Saint Lucie FI 34952
Legal Description: LAKE LUCIE ESTATES PLAT NO.ONE LOT 114(OR 982-2732)
Property Tax ID#: 3426-703-0128-000-8 Lot No. 114
Site Plan Name: N/A Block No.
Project Name: N/A
Setbacks Front N/A Back: N/A Right Side: N/A Left Side: N/A
DETAILED DESCRIPTION :OF WORK: ,
REMOVE ROOF SHINGLE
INSTALL TRI-BUILT PEEL AND STICK
INSTALL OWEN CORNING SHINGLE
CONSTRUCTION]
Additional work to be performed under this permit—check all appy:
HVAC Gas Tank ❑Gas Piping _Shutters Q Windows/Doors
Electric 0 Plumbing Sprinklers Generator Roof 512 Roof pitch
Total Sq. Ft of Construction: 2008 Sq. Ft.of First Floor: 2008
Cost of Construction:$ 12,000.00 Utilities:Sewer Septic Building Height: 81
OWNER/LESSEE;' CONTRA(TOR:
Name BARBARA SHANNON Name: MAURICIO ORELLANA
Address: 8221 MAIDENCANE PLACE Company: ONE CONSTRUCTION&ROOFING
City: PORT SAINT LUCIE State: FL Address: 2766 SW EDGARCE ST
Zip Code: 34952 Fax: N/A City: PORT SAINT LUCIE State: FL
Phone No.772-768-5666 Zip Code: 34953 Fax: N/A
E-Mail: N/A Phone No. 772-519-2449
Fill in fee simple Title Holder on next page(if different E-Mail: ONECONSTRUCTIONSERVICES@YAHOO.COM
from the Owner listed above) State or County License: CCC-1330623
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION UEN.LAW INFORMATION
DESIGNER/ENGINEER: pplicable MORTGAGE COMPANY: of Applicable
Name:BARBARA SHANNON Name:MAURICIO ORELLANA
Address:8221 MaidenonePla ort SaintL.d.F134952 Address: 8221 MAIDENC CE
City: PORT SAINT LUC State: City: PORT SAINT LU State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: pplicable BONDING COMPANY: _ of Applicable
Name: Name:
Address:2766 SW EDGARCE ST 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 Coun 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.
C CS. (D &Q 0.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF S\ COUNTY OF
The forgoing instrument was acknowledged before me The forigng instrument was acknowledged before me
this ay ofAt\5&A\k e-D 20��by this 4 "dEayof���r������ 20�by
Name of person making statement Name of person making statement
Personally Known_tom OR Produced Identification Personally Known -*--- OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Signattary Public-State of Florida) (SignatureofN tary Pub�l Stat
� '%� PAULETTE BLAIR-ALX DER
Commission No. -1 9J�Q Iss1 No. _=2• ea
y'" PAULETTE BLAIR ALEXANDER 4otary Public=State of orlda
oz's` °Bi,'•. Commission#FF 9 99
.°= Notary Public Sate of Florida �'}•,;fioFF�Qa.:�°, My Comm.Expires Se 2020
; L
Il'
P RP 1W
OFF�O ,% x ices Se 6.202C.
REVIEWS FRONT Z IN �.,�„�` SIE ��'SE� PLANS :VEGETATION SEA TURTLE MANGROVE
COUNTER RE E�11N° ` 'PREVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17