HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Syyo\� Permit Number:
RECEIVED
AUG 13 2018
Building Permit Applicatio
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 X
PERMIT APPLICATION FOR: �To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: 807 brack rd ft pierce fl 34982
Legal Description: hunt's s/d blk b lot 4and 5
Property Tax ID#: 3403 701 0031 000 4 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
reroof shingles to shingles remove exciting roof 30 felt underlayment
CONSTRUCTION INFORMATION:
Additional work to be nertormed under tispermit—check all appy:
HVAC Gas Tank ❑Gas Piping _Shutters Q Windows/Doors
Electric Plumbing Sprinklers 11 Generator F]Roof Roof pitch
Total Sq. Ft of Construction: 2100s Sq. Ft.of First Floor:
Cost of Construction:$ 7350 Utilities:0Sewer OSeptic Building Height:
OWNERAESSEE: CONTRACTOR:
Namedouglas albertson Name: roland wiley
Address:807 brack rd Company: shoreline roofing
City: ft pierce State:fl Address: 1973 sw Glendale st
Zip Code: 34982 Fax: City: port st lucie State:fl
Phone No. Zip Code: 34987 Fax:
E-Mail: Phone No. 772-260-9565
Fill in fee simple Title Holder on next page(if different E-Mail: shorelineroofing@yahoo.com
from the Owner listed above) State or County License: CCC1331170
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: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: 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 Counter 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
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencin ork or recording our Notice of Commence• n .
Signature of Owner/Lessee/Contract r as A nt for Owner Signature of Contractor/License Ho deri
STATE OF FLOIDA STATE OF FLORIDA
COUNTY OF - \-'14 c-\ COUNTY OF
The forgoing instrument was acknowledge before me The forgoing instrument was acknowledged before me
this�day of G,45 201 by this_\^13 day of <k ug ,20 Ik by
Name of person makIng statement Name of person m king statement
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identifica'on L_
Produced Produced IQ
(Signature of Notary Pub -Stat 1EGNENS (Signature of NotFrebWQAhbNEG1VENs
. DANA N#GG 0220^3 Y COMMISSION#GG 022023Commission No. I�ulMYC01'A l6,aenvOtilets Commission No. EXPIRES:DeQG�b�16,2020IRE fUn No�yi_pu6li�Underv+dtersd dNolarydedThN
a' e
'�1tE.F F•,O•�
REVIEWS FR NT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17