HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date
Permit Number:
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
PERMIT APPLICATION FOR: Roof
PROPOSED IMPROVEMENT LOCATION:
Address: ��� Iv P� PS Is�c,
Legal Description: NETTLES ISLAND INC, A CONDO -SECTION PARCEL 231 ANDPRO-RATA SHARE IN COMMON ELEMENTS
(OR 1079-274)
Property Tax ID #: 4502-501-0417-000-7
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Lot No.
Block No.
Reroof - shi`n le to towner supplied shingle and owner supplied peel and stick underlayment. 2/12
or,J NNb i� Vt 0
CONSTRUCTION INFORMATION:
Additional work to be bertormed under t ispermit — check a appy:
HVAC LJ Gas Tank ❑Gas Piping Shutters Windows/Doors
11 Electric ❑ Plumbing Sprinklers nGenerator ✓❑_ Roof 212 Roof pitch
Total Sq. Ft of Construction: 1000
Cost of Construction: $ 2Q99 :..
S. Ft. of First Flodr,1000
Utilities: _ Sewer D
Jeptic Building Height: 12
OWNER/LESSEE: - _;
CONTRACTOR:
Name Paula Doll
Address: 231 Nettles Island\
Name: Jon Ashenback
Company: Atlantic Construction and Roofing
Address: 4888 N Kings Highway #229
y Jensen Beach,
City: State: _
Zip Code: 34957 Fax:
Phone No. 732-616-6588
City: Fort Pierce State: FI
Zip Code: 34951 Fax: 7722640302
Phone No. 7722153306
E -Mail: Lpeszdo115@aol.com
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E -Mail: Atlanticonstruction@gmail.com
State or County License: CCC -057852
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: Jensen Beach, State:
Zip: Phone
City: Fort Pierce State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
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
improve ents to your property. A Notice of Commencement must be recorded and posted on the jobsite
before th�first inspection. If you intend to obtain financing, conolt with lender or an attorney before
commen g work or recording your Notice of Commencement
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If C ntractor/License Holder
fighatureof wner/ Lessee/Contractor as Agent for Owner
STATE OF LORIDA
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STATE OF FLORIDA
COUNTY OF +
COUNTY OF
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The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this day of 20_ by
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Name of person making statement
Name of person making statement
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
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Produced
I— ;#`,. Notary Public Stab Od Florida
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(Signature of Notary P f M36081:ic - State of Flor--
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Rev. 8/2/17