HomeMy WebLinkAboutbuilding Permit ApplicationSUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
MORTGAGE COMPANY: _ Not Applicable
N a me: Jon Ashenback
Address: 6007 Fort Pierce NO
City: Fort Pierce State:
Zip: Phone:
City: Fp State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address: 4888 N Kings Highway #229
City:
BONDING COMPANY: Not Applicable
Name:
Address:
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 Commenceme t must be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing, onsult with lender or an attorney before
comme�icc ngvorQr recording your Notice of Commencem t.
Signat r of Ow er/ Lessee/Contractor as Agent for Owner
Signatur f Contractor/License Holder
STATE OF FLORIDA
STATE 0 FLORID
COUNTY OF SS��,,,u� _
COUNTY OF ,
The forgoing instrument was acknowledged before me
The Wing instr ent was acknowledged before me
this day of 201a by
thisday of 20Z by
Name of person making statement
Name of person making statement
Personally Know OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature of Notary Public- State o Florida
tsigp&dre of Notary Public- to of Florida )
Commission No. (Seal):,MNAINGRAM
Commission No. .......(Seal)
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'�. •t :. PJotary Public - State of Florlda
,•�* o INGR7ftrida
'�°. �` Notary F r7te o
My Comm. Expires Dec 20, 201a
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REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date
CaU it T L .
F L O R 1 D .A Jgo
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 X
PERMIT APPLICATION FOR: Roof
PROPOSED IMPROVEMENT LOCATION:
Address: 6007 Fort Pierce Blvd, Fort Pierce, FI 34951
Legal Description: LAKEWOOD PARK UNIT 5 BILK 52 LOT 3(MAP 13/02S)(OR 1727-2540; 2980-867)
Property Tax ID #: 1301-605-0269-000-7
Site Plan Name:
Lot No.
Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Reroof - shingle to owner supplied shingle and owner supplied peel and stick underlayment. 4/12
CONSTRUCTION INFORMATION:
Additional work to e er orme under this permit — check a that apply:
�HVAC 11 Gas Tank Gas Piping ❑_ Shutters Windows/Doors
Electric ❑ Plumbing ❑ Sprinklers Generator Roof 4�1 2 Roof pitch
Total Sq. Ft of Construction: 1000
Cost of Construction: $ 11,500
S . Ft. of First Floor: 1000
Utilities:CnSewer Septic
Building Height: 12
OWNER/LESSEE:
CONTRACTOR:
Name Linda Dreas
Name: Jon Ashenback
Address: 6007 Fort Pierce blvd
Company: Atlantic Construction and Roofing
City: Fp State: Fl
Zip Code: 34951 Fax:
Phone No. 772-501-3693
Address: 4888 N Kings Highway #229
City: Fort Pierce State: FI
Zip Code: 34951 Fax: 7722640302
Phone No. 7722153306
E-Mail:
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-o57852
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.