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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: I .5----65Z3�
COUNTY .. #008
Building Permit Application P/1 ,nQ 'O18
Planning and Development Services Cpl 9IPart.
Building and Code Regulation Division #6 ent
2300 Virginia Avenue,Fort Pierce FL 34982 /
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential v
PERMIT APPLICATION FOR: Roof
PROPOSED IMPROVEMENT
LOCATION:
Address: 11 6ts ( GIc-IC k/C, ��``,I �-V\eft-- ri
Legal Description: LcD.k Q Wt1 4 Pa..rl- kYN 1't - 5
Property Tax ID#: \3 - t b5-0ICO_ 000-5 Lot No. 3- 4
Site Plan Name: N/A Block No. 1-1-4
Project Name: N/A
Setbacks Front N/A Back: N/A Right Side: N/A Left Side: N/A
DETAILED DESCRIPTION OF WORK:
NIS. V\11 A \ 0-C---c -k-\,..4- vQ5 . 5 w �.t rooF, �ad1 0- --F- ^-- f k-•Nwooci. 'tc
C�,tvve'n.+ Codes Ok"Ot lh S1(-A.1\ tnii,4 5A v(oay + 0.4A A's OW* t,ws)W5
CONSTRUCTION INFORMATION:
Additional work to be erformed under this permit-check all- apply:
DI HVAC [1Gas Tank LiGas Piping Shutters El Windows/Doors
El Electric El Plumbing
Plumbing Sprinklers Generator I I Roof 3//il Roof pitch
Total Sq. Ft of Construction:/� S . Ft.of First Floor: N/A
Cost of Construction:$ In 1 11O.l�q J0 Utilities: Sewer 111 Septic Building Height: N/A
OWNER/LESSEE: CONTRACTOR:
Name 3r+ Name: Christopher Collins
Address: g,11:;01 (�A,1 Yla ANIi- Company: Collins Roofing Inc. 1
City: Ft,. (tfia, State: FL Address: P.O. Box 12867
Zip Code: ; )1 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: 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.
r SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: t
DESIGNER/ENGINEER: lNot Applicable MORTGAGE COMPANY: le Not Applicable
Name: Name:
Address: Address:
City: State: City: Ft.Pierce State: i
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: leNot Applicable BONDING COMPANY: leNot Applicable
Name: Name:
Address: P.O.Box 12867 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 represu
sentation that is granting a permit will authorize the permit holder to build thesubject 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 1
in accordance with the approved plans,the Florida Building Codes and St.Lucie County Amendments.
The following bu' : ng p- mit a.• • - ions are exempt from undergoing a full concu - y revie'••room additions,
accessory sty.. ures,swi •• ng pools, • ces,walls,signs,screen rooms and . essory uses to an., •- non-rest.:ntial use
WARN ,G TO O f" :Your failur:to Record a Notice of Com •ncement m. • n your paying' ice for
impr.vement •ur prope A Notice of Commencem--t must be -c. :rd . • ••. .• on he jobsite
be •re the fi1ection�,4o intend to obtain financi,g, consul r ' -n• > • ., orne before
c. mencfoofr:' . r di•7_,-• your Notice of Commen ement.
1 --:.• ie
at - . •• er Lesse- Contractor as Agent for Owner Signa re o Contractor/License Holder
STATE OF FLORIDA� (�� // � � STATE OF FLORIDA 6t_iiiLtik
�COUNTY OF V )� (pl c(�I COUNTY OF
The fo oing instrument was acknowledged before me The forgoing instru nt was acknowledged fore me
this day of 20 /rby by this day of `� / ,20 1 y by
Nam�erso akin statement
44 eidh-ltps
Na@iw4
in statement P g
g
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced 41 / Produced /
APFAP7 /
(Sig 7A ota •�of tic,J1pt o . t.�, (Signa�ro'N ata ublic-State of Florida) _
� :EY FRENCH •
/n7 a+� Notarryy_�Publi —State of Florida ((ll� •r...; SEY FRENCH
Corn issi. No.U&l 1 ' j1) Cottlibil #GG 167258 Commission No�lJl f(�� S'= Nl�
-;•'a; A ; My Comm.Expires Dec 11,2021 Fillid4.411h"4"141h"."."1"11...,'` !�°• blio—State of 258da M
Commission#GG 167258
? t;!„„` Bonded through National Notary Assn. ” :•'ky, a o'./My Comm.Expires Dec 11,2021 P
1 s. 8e•t,+ed 4r^ugh National Notary Assn. `
REVIEWS FRONT ZONING 'SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17