HomeMy WebLinkAboutROOF - FIBERGLASS SHINGLE All APPLII�CABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED a'
Date: I ,qOI Permit Number:
RECEIVED
SEP 18
Building Permit Applica ion
ST. Lucie County, Permitting
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:
P'R POSED INPROVEM`E T LOCA 10`N:
Address: q �
�6 35 40 BEG AT INT OF::N 43 STAND:aV Q RUN N ALG W FJW N 43 ST 13 FT TE i W 150 FT,THIS 134 FT TO N
g P .:
Legal Description.- R/W AV.:Gt,TH:E.f FT TO.W RiW N4'3- ST AND POB{9Aj:{q 46.1 Gj�C7R 664 4$5:853 17g� 1189 167,.X629.334)
Property Tax ID#: � � - r 0M � '\ ) Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Ffont Back: Right Side: Left Side:
Q TA LED DE�SCRI'PTION 0021211
G
t r, 1
@O` STRIUCTI'M NI INFO MATEOIS
Additional work to be performed under this permit—check a that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers _Generator _j-Z/Roof Pitch
Total Sq. Ft of Construction:- I o�-� Sq. Ft. of First Floor:
Cost of Construction: $ o[ LQ Utilities: _Sewer " Septic Building Height:
®V1/NER/LESSEE: CONTRACTOR:
Name Name: Z 1 u� fir,
Address:Li 3ME� r1�1~, U1 ' M Company: P�(lr(.
` ^G
City: + ;�:e "{% :,,i�+ � ?J State: Address:-9�0LP'
Zip Code: 3 r —7 Fax: City: [ L'iZC� Stater
Phone No-1110 a�� 't r 6n"1 0 Zip Code: O Fax: `--
E-Mail: Phone No° d� q, '1q
Fill in fee simple Title Holder on next page(if different E-Mail S
from the Owner listed above) State or County LicenstC C 13,9'1 o9 975
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SU`A'PLEM�N7AL CONSTt�f CTION L SEN LAW I� �FORMATI®N:.
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 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 Commencement must be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing, c nsult with lender or an attorney before
co encin work or re rdin our Notice of Commenceme t.
Si nat re of Owner/Lessee/Cont ctor as Agent for Owner Signa of ontractor/License (older
STATE OF FLORIQ ST E OF FLO IQAZ r
COUNTY OF COUNTY OF 1>>4IW--
The for oing instru en�tJ�vas a tnowledge efore me The for oing inst a as 'knowledge fore me
this']day of /U 20�by this ay of 20 y
'1)6t"�,
(Nam of erson acknowledging) (Na a of pe on acknowle ging)
(Signature of Notary Public-State of Flori a) ( ignature of Notary Public-State of Florida)
Personally Known OR Produced Identification . Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced f�� "' Kimberhm M.Garwood Produced ' (� berM 04 1142111 d
Commission 75422 �,� mission GG17
Commission..�.. O ires:JaDuarl1�, Commissions , :�� Ua 1 *I)
Bonded thru Aaron Notary g' Bonded thnJ Aamn�Notary
�i��OFF►`��� q��nhn �'�
REVIEWS FRONT ZONING SUPERVISOR PLANS ' VEGETATION SEA TURTLE MANGROVE
COUNTER •;REVIEW -.REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 7/2014