HomeMy WebLinkAboutBuilding Permit Application ' ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: � Permit N
IVSD
AUG 0 9 2018
Building Permit Applicati9, Lude COUMtYj P@rmitung
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: 013 TioJigr, •1a BDrrp R_
Legal Description: lrll h L (1 5. ;--Atrw( S Felt SS L-0+
Property Tax ID#: �� C� �' �a' a��3 400 4 Lot No. to
Site Plan Name: N/A Block No. 55
Project Name: N/A
Setbacks Front N/A Back: N/A Right Side: N/A Left Side: N/A
DETAILED DESCRIPTION OF WORK:
We, Wtv\ +Z()..r per' `Vwt, �xtS-�ctri S�.�v�4� roch� c�vY.�l nous
Ct et-Ac— ofF +0 CL,*-r e^4,- Cedt_ <<� OL V%LW
CONSTRUCTION INFORMATION: V
A iti.ona wor to e e orme under this permit—check a appy:
❑HVAC Ei Gas Tank ❑Gas Piping _Shutters ❑Windows/Doors
❑Electric ❑ Plumbing ❑Sprinklers ❑Generator Roof Roof pitch
Total Sq. Ft of Construction: 113 Sq. Ft.of First Floor: N/A
Cost of Construction:$ Imo.��) Utilities:0Sewer❑Septic Building Height: N/A
OWNERAESSEE: CONTRACTOR:
Name Name: Christopher Collins
Address: 1 Company: Collins Roofing Inc.
City: R.Ptes.e_ State:fit.. Address: P.O. Box 12867
Zip Code: 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: collinsroofingincpa 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: Address:
City: State: City: R.Pierce State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: . _ Not Applicable BONDING COMPANY: 10�Not 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 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 struct s;s immi oo s, ces,walls,signs,screen rooms and acccee o use to another non-residential use
WARM G TO OW :Your failur to Record a Notice of Comme cr�'ement ma sui�ppust,
ying twice for
impr ements r property. Notice of Commenceme must be rded aon the jobsite
be re the fir section y intend to obtain financi , consul a der or an att ney before
c mmencin o or r rdi our Notice of Commencement.
gnature of Owner Lessee/Contractor as Agent for Owner Signature of Co r tcense Holder
STATE OF FLORIDASTATE OF FLORIDA
COUNTYOF �� �� COUNTYOF
The fo oing instrument was acknowledge before me The f rgoing instrum nt was acknowledged, efore me
t is�day of 20 by this day of 20 1 by
�ns\ \ M/
Name of pers making statement Name t perso making statement
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
OX _4��1�— I
P
CASEY FRENCH
tY 1 i''
(Signa ure N ary Public- to Tp.6 public-State of Florida (Signatur ublic- te,o•• Q
a�y ;,••,P{aY 1•+ CASEY FRENCH
w'':
•: •= Commission#GG 167258 " �♦P•; Notary Public-State of Florid
Commi on No.• �y +r�oY:'I(tlSe�}m.Expires Dec 11,2021 Commission No. ♦•;(S®a6)nission#GG 167258
Bonded through National Notary Asan. `-.yo+ +�� My Comm.Expires Dec 11,202
Bonded through Naf onat NolaryAssn
REVIEWS _ FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17