HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED / r�1
Date: 11/16/17 Permit Number: !�,? V43, �
Building Permit Application
Planning and Development Services NOY 16 2017
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 —5h[4' lLQ_
PROPOSED IMPROVEMENT LOCATION:
Address: t e [ZcnoltEiL (-
Legal Description: 19 36 41 N 225 FT OF S 445 FT OFN 1038.84 FT OF GOVT LOT 2 LYG EOF FEC RR WITH
RIP RTS-LESS S 68.8 FT OF E 224.73 FT-(2.49 AC)(OR 1363-1117:2892-1124)
Property Tax ID#: 3519-411-0001-000-1 Lot No.2
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
TEAR OFF EXISTING SHNGLE ROOF AND INSTALL A NEW SHINGLE ROOF
CONSTRUCTION INFORMATION:
Additional work toe nertormed under this permit—check a appy:
HVAC Gas Tank Gas Piping _Shutters Q Windows/Doors
11 Electric 0 Plumbing Sprinklers ElGenerator Roof 8f!12 Roof pitch
Total Sq. Ft of Construction: 3400 Sq. Ft.of First Floor:
Cost of Construction:$ 17850 Utilities: Sewer ElSeptic Building Height: 2 STORY
OWNER/LESSEE: CONTRACTOR:
Name E e(` Name: S
Address: C fi R03 5 `ncu RiY� (1 Company: Ik-4(4
City: ffi -pi-erCe— State:_�L Address: 390A 5 WS
Zip Code: J"lggo1 Fax: City: l uC-e State.
Phone No. 1:1 a1 _506-10 Zip Code: r 5qq g Fax: 772-464-6600
E-Mail: Phone No. 772-464-6800
Fill in fee simple Title Holder on next page(if different E-Mail: JENNIFER@ALLAREAROOFING.COM
from the Owner listed above) State or County License: CCC1326177
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW''INFORMATION:
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 thepermit 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.
Signat of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF Sr LUCIE COU NTY OF ST LuaE
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 16 day of NOVEMBER 20 j-1 by this 16 day of NOVEMBER 2012 by
CHARLES RICHARDS CHARLES RICHARDS
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
R \
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ignature of Notary Public-State
,v9f Florida) (Signature of tary Public-State of Florida)
t FAITH MASON
a°•• ��'� ti�RYP% FAITH MASON
Commission No. * * @@MISSION#GG 003939 Commission No. °'•••�O( LdMMISBIbN#G000393
w c� EXPIRES:June 20,2020
9rFOFFTI Bonded Thru Budget Notary Services m1 \°< dadT ruguti Ite20,y020
lFOFF��� Bonded 7iw Budget NoiaryServket
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17
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