HomeMy WebLinkAboutROOF - FIBERGLASS SHINGLE All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED / /��
Date: Permit Number: /YO/ �00 1
a
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 1/
PERMIT APPLICATION FOR:
PROPOSED II ' ROVEMENTyLOCATIN
. _"
Address: Ali
Legal Description:_
Property Tax ID#: 7 `-' ® < Lot No.
Site Plan Name: � � wL�e,r�-6' Block No.
Project Name: Lo C� 1�e- o r
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIP'I-.ION ����Rlii u£ ° ` � d � F �
�w v
�O
WC'TI 1 INI=0R11 lATION
itionaI work to e p rtormed under this permit-check all that apply:
_Mechanical _Gas Tank —Gas Piping _Shutters Windows/Doors
_Electric _Plumbing _Sprinklers _Generator LlRoof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction: $ Utilities: —Sewer _Septic Building.Height:
DINNER/LESSEE GOI�ITRACTOR
Name
Address: r1b y, 6 LI 6nnpa.ny?.,;T:
City: ► tO r G C State:
Zip Code: 123 Q, _Fax: City: State:--
Phone No. ria `J ' 6 Zip Code: Fax:
�Dftl Phone No
Fill in fee simple Title Holder on next page(if different E-Mail.
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION.
DESIGNER/ENGINEER: Not App+ licable MORTGA _,•.,
_ F � MP Not Applicable
Name: Name: Ne,
Address: Add reps: d D z'
City: State: City: 1: ! State:
Zip: Phone Zip: D - t/o�ne:JA (• 565
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
cornmencing work or recording our Notice of Commencement.
Si nature of Owner/Lessee/Contractor-as Agent for-Owner• SignaSure_of Contractor/License Holder
STATE OF FLORID LL l STATE OF FLORIDA
COUNTY OF <S-r- l CSI'(. COUNTY OF
The for ping instrum nt was acknowledge before me The forgoing instrument was acknowledged before me
thi 1�- day of JChh 20'D by this day of 20_ by
(Name of per on acknowledging) (Name of person acknowledging)
(Signature of Notary Public-St fe of Florida ) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced L TAYLOR Produced
YCpI{MISSION 1Ff1 I
Commission NoTP S� Y InTems:February.42N' Commission No. (Seal)
BondedTDruNob�ry
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REV!EW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
. DATE
COMPLETED
ev.