HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: - �U Permit Number: 41 J7
•
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 Yes
PERMIT APPLICATION FOR: Roof
PROPOSED IMPROVEMENT LOCATION:
Address: Ft
Legal Description: VY 1 �e r
Property Tax ID#: 73()5— Lot No.
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:
We will tear off the existing roofing down to elywood, � ..� rc,
l�x U�zv`AM�� OV44AkS (::4wvvn 06, c Icky_ 5� 1
tm�s t�l►Z p - k.
CONSTRUCTION INFORMATION:
Additional work to be oertormed under t ispermit—check all appy:
HVAC Gas Tank Gas Piping Shutters ❑Windows/Doors
❑Electric ❑ Plumbing FISprinklers Generator Roof
Total Sq. Ft of Construction: G ll S Ft. of First Floor: N/a
Cost of Construction: $ I �� Q15W Utilities:0Sewer[]Septic Building Height: N/a
OWNER/LESSEE: CONTRACTOR:
Name Name: Christopher Collins
Address: Company: Collins Roofing Inc
City: State: Address: PO Box 12867
Zip Code' Fax:N/a City: Fort Pierce State: FL
Phone No.N/a Zip Code: 34979 Fax: 772-489-6505
E-Mail:N/a Phone No. 772-201-1352 or 772940-8607
Fill in fee simple Title Holder on next page(if different E-Mail: Collinsroofinginc@gmail.com
from the Owner listed above) State or County License: CCC-058011
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: V_Not Applicable MORTGAGE COMPANY: d_Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: d_Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
St.Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules,bylaws or and covenants that may restrict or prohibit such
structure.Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this r nested permit,I do hereby agree that I will,in ects,perform the work
in accordance wi a appro ans,the rida Building Codes and St.Lucie Co Amendments
The folio ' g buildin rmit applications are xempt from undergoing a fu oncurrency r ew: oom additions,
acces ry structur ,s imming pools,fences, ails,signs,screen rooms d accesso ses to an ther non-residenti I use
RNING T ER:Your failure to ecord a Notice of C mence t m es in your paying ice for
proveme s o our prope . A tice of Commence ent mu a de and posted on t e jobsite
before th i t' spection ou i end to obtain finan ing, con I I en r or an attome efore
comm rk or ur Notice of Comme cement
s
_Signature of Own essee/Agent SI na a of C icense Holder
STATE OF FLORIDA S`1 Z4J? p STATE OF FLORIDA
COUNTY OF (� COUNTY OF
The for oing instruMent was acknowledge before me The forgoing instr ent w7as acknowledged before me
this�rtday of ' t 20/f by thi day of 20�$by
lame of person ack owledging (Name of erson acknowle Ing, .....,,
�µr ry,'••. BELINDA DARDEN
�' Nota Public--State of Florida
BELINDA DARDEN - AL1•" Notary�'t rI • Commission#GG 169025
:'. ;s.`•.
Notary Public—State of Florida „,:III „r
•: �• Comrrdssicn#GG 169025 =•;;,,` My Comm.Expires Dec 18,2021
(Signature of Notary ii , : t (Signature of Notary Public
S UM ....,. . Ihrrwyh Nalioml No!aryAssn.
bundo I Ml o lional No!ary Assn.
Personally Known OR Pro uced Id ntification Personally Known OR Produced Identification Y
Type of Identification Produced p OLC 11�q I) — Type of Identification Produced
Commission No. (Seal) Commission No. (Seal)
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS