HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: L
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Building Permit Application JAN
Planning and Development Services 2
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 /
Phone: (772)462-1553 Fax: (772)'462-1578 Commercial Residential
PERMIT APPLICATION FOR: Roof
PROPOSED dMPROVEMENT LOCATION ,
Address:
2023 St Lucie Blvd Ft Pierce FI 34946
Legal Description: Whispering Pine Co-Op Unit 313
Property Tax ID#: Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
[DETAhL 'I'ED DES CRON'OF..WQRK:
Reroof Shingles to shingles
CO,NSTRUCTION,INFORMATION
Additional work to bfiGasTank
orme under this permit—check a appy:
11HVAC Gas Piping OGenerator
Shutters Windows/Doors
❑ P g Electric ❑ Plumbing ❑Sprinklers Roof Roof pitch
Total Sq.Ft of Construction: S . Ft.of First Floor: 2000
Cost of Construction:$ 6000 Utilities: _Sewer[]Septic Building Height:
OWNWLESSEE CONTRACTOR:
Name Mary Pawlus Name: Roland Wiley
Address:2023 St Lucie Blvd Company: Shoreline Roofing
City: Ft Pierce State:Fl Address: 19738W Glendale St
Zip Code: 34946 Fax: City: Port St Lucie State:FI
Phone No. Zip Code: 34987 Fax:
E-Mail: Phone No. 772-260-9565
Fill in fee simple Title Holder on next page(if different E-Mail: shorelineroofing@yahoo.com
from the Owner listed above) State or County License: CCC131170
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
TA
SIJPPLEMENT L CONSTRUCTLON LIEN LAW INFQRIVIATION
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
orrimencin g_Work or recording your Notice of Commencement.
SigRature of owner/Lessee/CaAUZ—or as Agent fo OWnei Sig flature-of Contractor/License 114djEjr
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LORID0 3) 55
STATE OF FLORIDA L
STATE OF F
COUNTY OF =93 COUNTY OF
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The forgoing insti, t was acknowledged ing, trp�ent w -if�x
,Aefore Th f ins as acknowledged befor n LU
this f)(1 day of vi 201X by �i UJ day of 20/(S' co
7=17: thi;X by
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Name of person -making statefnent Name of person making statement
Personally Known OR Produced Identificatio Personally Known OR Produced Identificati
Type of Iden'tilicition .... Type of Identification
Produced r - Produced -
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(Signature"of Nota State of Florida. l (Signature of Nota /`blic-State of Florida V U
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17