HomeMy WebLinkAboutROOF - FIBERGLASS SHINGLE go In i try-4-'e
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED V�
Date: a� a.31 \� Permit Number:
RECEIVED
OCT 2 3 2018
.Building Permit Applicata rtT, Lud.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
PERM ITAPPLICATION FOR:
Address: 1 to '0 -e C
Legal Description:
Property Tax ID#: "l 0l' V Lot No.
Site Plan Name: Block No.
�. Project Name:
k Setbacks Front Back: Right Side: Left.Side:
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Add itiona I work to a pe rforrned under this permit–check
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:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers _Generator _Roof d 2 Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$(7.. Z®� Utilities: —Sewer —Septic Building Height:
Name r f' Name:
Address: C) Company:
City: 4 0 State: ., Address:
Zip Code: ® Fax: City: State:
Phone No. ` ��� '( Zip Code: Fax:
E-Mail: Phone No
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
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 thepermit 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
commencinp,work or recording our Notice of Commencement.
6t e
Signature of Owner/Lessee/Contractor as gent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF 4)r..- COUNTY OF
The forgoing'instrument was acknowlecigefore me The forgoing instrument was acknowledged before me
this;LrA,day of -0cAb .20�Vby this day of .20_ by
a c A.a-1 d,
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary P lic-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Prod rsonally Known _ OR Produced Identification
Type of Identification , �•�..,,, DEANNAMAR►EG-R pe of Identification
Produced D 1- :P1' �; MY COMMISSION#GG oduced
s�;. :oma_ EXPIRES:December 18,2020
r No.,jpU tUndwwd
Commission No.-Er46 .,;:•r a mmission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW . REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.