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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: X13�1$ Permit Number:
RECEIVED
Building Permit Applical ion MAY 0 3 2018
Planning and Development Services ST. Lucie County, Permitting
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 -3�►�'� 114"
PROPOSED IMPROVEMENT LOCATION:
Address: 10851 S Ocean Drive lot 92 Jensen Beach
Legal Description: Windmill village by the sea condominium No 1 unit 92 And pro rata
Property Tax ID#: 451181000990008 Lot No. 92
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Replace shingle roof with shingle roof v h .p,i u v1 k, •-1 v f 4-ee-
CONSTRUCTION INFORMATION:
Additional work to e e orme under this permit—check a appy:
HVAC Gas Tank []Gas Piping _Shutters Q Windows/Doors
11 Electric 0 Plumbing Sprinklers Generator Z Roof 4/12 Roof pitch
Total Sq. Ft of Construction: 1100 S . Ft.of First Floor:
Cost of Construction: $ 4400.00 Utilities:nSewer E]Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Elaine Schulkin Name: Dee Keihn
Address: 10851 S Ocean Drive Lot 92 Company: PDK Roofing Inc
City: Jensen Beach State: FL Address: 626 SW Everett Court
Zip Code: 34957 Fax: City: Port Saint Lucie State: FL
Phone No. Zip Code: 34953 Fax:
E-Mail: Phone No. 772-528-0113
Fill in fee simple Title Holder on next page (if different E-Mail: PDKRoofing.inc@gmail.com
from the Owner listed above) State or County License: ccc1331408
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:Elaine Schuikin Name:Dee Keihn
Address: 10851 S Ocean Drive lot 92 Jensen Beach Address: 10851 S Ocean Drive Lot 92
City: Jensen Beach State: City: Port Saint Lucie State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: 626 SW Everett Court 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
beforpAhe first inspection. you ' tend to obtain financing, co sult with lender oran attorney before
com n in work or re ir Ing Jour Notice of Commencem t.
Signature of Owne Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF SA-. COUNTY OF S•} , L,x•�
The forgoing instrument was acknowledge before me The forgoing instrument was acknowledgeq before me
this 3 day of� 20 by this_�"2 day of YT\INy 20M by
Name of person making statement Name of person making statement
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identifica 'on Type of Identifi ation
Produced L fl t-- Produced—V L 1Q L
(Signature of Not Pub tc-S e Ff�oda J�0 (Signature of Notary Put�FS to cif: fi arc�p� ),�tEG��
D 1�vK ,ON �� " AISSIOId#GG 022M�
Commission No. 1 OM4A1S�516.1'l` 3 •'• MyGOM• r16.20�
:.,FcS' Commission No. FXPtarSicUndeiwri;;
gond gedmrotiotanF�b ��'-. .+:+' . .P:= 6ond,:dlixuNotary �-•--
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REVIEWS MO-NT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17