HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Number: �107�- o �sq_
RECEIVED
Building Permit Application MAR 2 8 2018
Planning and Development Services
Building and Code Regulation Division ST, Lucie Count , Permitting
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: Roof ��
PROPOSED IMPROVEMENT LOCATION:
Address: 5500 5+ Lut t 51 il -i T:�' P\QT-L!c E P-C-3
Legal Description: 3 , + Lk) 15 olp SV'( I* IGSS Gift rIF er k�m_pn a tart -'-- �312. i�*
PropertyTax ID#:J 1}30 - ` - � 2-b(�(')- S 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:
Wc.. W kk\ C)�: -kv� Voc;i�� a^a 'fie. roc."�-
vii r-1,, S Gly o\ck kA-5kV vtrno� la. a v�o� o15�ha.�t 5�., `•-S.
CONSTRUCTION INFORMATION:
Additional workto a er orme under this permit-check a apply:
HVAC Gas Tank OGas Piping Shutters E]Windows/Doors
11 Electric Plumbing Sprinklers Generator R] Roof Roof pitch
Total Sq. Ft of Construction: I :!� Sq. Ft.of First Floor: N/A
Cost of Construction: $ 4, M Utilities:Sewer O Septic Building Height: N/A
OWNER/LESSEE: CONTRACTOR:
Name RX C Name: Christopher Collins
Address: 55 S+ LAA.0 it AVd Company: Collins Roofing Inc.
City: IR _ 'lexcs_ State: Address: P.O. Box 12867
Zip Code:3Hrq We D Fax: N/A City: Ft. Pierce State: FL
Phone No. N/A Zip Code: 34979 Fax: 772-489-6505
E-Mail: N/A Phone No. 772-201-1352
Fill in fee simple Title Holder on next page( if different E-Mail: coil insroofinginct?a 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: Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: _ Name:
Address: Add ress:
City: State: City: Ft.Pierce State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: IrNot Applicable
Name: Name:
Address: P.O.Box 12867 Address:
City: City:
Zi p: 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 ran t g of this re ermit,I do hereby agree that I wil i all respects, erform t
in accordance thea ppro d pl a Florid Building Codes and St.Lucie my Amendments
The folio i g building permi pplications are exe pt from undergoing a f concurrency revie .ro m additions,
access structures,swi m' g pools,fences I ,signs,screen room nd accessory use - of er n -residential use
W NING TO O Your fail t ord a Notice of C mmencement esul your payin is or
i provements o p e o ice of Commenc ent must b r nd post n. e ' bsite
efore the f' I c 'on y int nd to obtain fina cing, consul d ora a fore
commenc' r or ' / /r Notice of Comm ncemen
v
Sin a of Owne ee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA / ^ , STATE OF FLORIDA
COUNTY OF � b_tl:I _ COUNTY OF
The fo oing instrument was ar,knowledge before me The for oing"strum nt was sack owledged before me
this day of / 20 by this day of 20� by
Name pe making statement Name of p rso/nmaking statement
Personally Known ✓ OR Produced Identification Personally Known ✓ OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(sign f ot (Signatu o ary is a. t
;;;r% "• CAS6FRENDkssm)
„Y, A EYFRENCH
+�'•; + Notary Public-State of Florida
Commission No. /� € f'-. Notary 1019�a late Commission No. / Z/! �;
Corri4fOW%GG 167258
_ Commission GG Y MY Comm.Expres Dec 11,2021
My Comm.Expires D
Bonded through National Notary Assn.
Bonded through National
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DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17