HomeMy WebLinkAboutPermit appALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 12/14/17 Permit Number:
CUNTY
,R:,. 0,
O.Jq2
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 - ,�I I y� 9.�
PROPOSED IMPROVEMENT LOCATION:
Address:
Legal Description: 17 3540 FROM NW COR OF SW 114 OF NW 114 OF SW 114, RUNE TO INTOF HARTMAN RD, TH S 160 FT, THE TOW RIW TOTTEN RD FOR POB, TH N 160 FT, TH W 160 FT, TH
S 160 FT, TH E 160 FT TO POB (0.59 AC) (OR 518-1158: 1031-2882, 2883: 1052-322: 1075-1568 ; 1918-2280; 2054-1729: 2891-1973: 2895-1634; 3072-1644; 1647; 1649)
Property Tax ID #: 2417-323-0001-000-5 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
IDETAILED DESCRIPTION OF WORK: I
TEAR OFF EXISTING SHINGLE ROOF AND INSTALL NEW SHINGLE ROOF
CONSTRUCTION INFORMATION:
Additional work toa nertormed under this permit— check all appy:
HVAC Gas Tank []Gas Piping _ Shutters ❑ Windows/Doors
11 Electric ❑ Plumbing ❑SprinklersGenerator W1 Roof 512 Roof pitch
Total Sq. Ft of Construction: 1750
Cost of Construction: $ 7700
S Ft. of First Floor: _
Utilities:[]Sewer 0Septic
Building Height: 2 STORY
OWNER/LESSEE:
CONTRACTOR:
Name DCk,
Name: TJ_k-C
Address:
Company:
Address: ��4'z
City: )� {',rC�-- State: F�
Zip Code: Fax:
Phone No, ���a ` ,�)��— ("� ,"7 �]
City: El 0" e-rics Stater
Zip Code: Fax: 772-464-6600
Phone No. 772-464-6800
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E -Mail: FAITH@ALLAREAROOFING.COM
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
Name:
MORTGAGE COMPANY: Not Appl icable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
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 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
comm cin work or recording our Notice of Commencement.
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S ature Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF STLuaE
COUNTY OF STLUCIE
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this /q day of 2017 by
this ILI day of l� c'� rvLlr�-P,r"" 20 1 `1 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
1 n�
-(S' ature of Notary Public- State 9f Florida)
(Signature of Notary Public- State of Florida )
FAITH MASON
0 0
'�.+Iy f'ud
., 4c MASON
Commission No. * LI(Si?MMISSION#GG003939
�`FA�ITH
Commission No. ,r �1�g�IW11SSION # GG 003939
+ \oma EXPIRES: June 20, 2020�oz
*
EXPIRES: June 20, 2020
F�oP Bonded Thru Budget Notary Services
:- pt oBonded Thru Budget Notary Services
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COMPLETED
Rev. 8/2/17