HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 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 XX
PERMIT APPLICATION FOR: Roof
PROPOSED IMPROVEMENT LOCATION:
Address: 676 SENEGAL COURT, FORT PIERCE
Legal Description: PALM GROVE SID BLK C LOT 16
Property Tax ID #: 3410-503-0084-000-4 Lot No.
Site Plan Name: Block No.
Project Name: SHUTT/REROOF
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
TEAR OFF SHINGLES, RE -NAIL DECK. INSTALL NEW OWENS CORNING DURATION SHINGLE
ROOF SYSTEM OVER 30# FELT UNDERLAYMENT.
CONSTRUCTION INFORMATION:
Additional worK to be e ormIN: un eT I s Permit—c ec aappy:
❑_IHVAC Gas Tank ❑Gas Piping _Shutters Windows/Doors
L _I Electric Plumbing Sprinklers Generator 21 Roof 6/12Roofpitch
Total Sq. Ft of Construction: 3,300 5c �I�Ft. of First Floor: 1,972
Cost of Construction:$ 9.900 Utilitiest] Sewer Septic Building Height: l STORY
OWNER/LESSEE:
CONTRACTOR:
Name MARLYN SHUTT
Name: KYLE WHITE
Address: 676 SENEGAL CT
Company: J.A. TAYLOR ROOFING INC
City: FORT PIERCE State: FL
Address: 302 MELTON DRIVE
Zip Code: 34982 Fax:
City: FORT PIERCE State: FL
Phone No. 772-595-3709
Zip Code: 34982 Fax: 772-468-8397
E -Mail: MSHUTT2@BELLSOUTH.NET
Phone No. 772-466-4040
Fill in fee simple Title Holder on next page I if different
E -Mail: NADINE@JATAYLORROOFING.COM
from the Owner listed above)
State or County License: CCC1325895
If value of construction is $2500 ar more, a RECORDED Notice of Commencement Is required.
SUPPLEMENTAL CONSTRUCT9N LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
Name:
_ Not Applicable
MORTGAGE COMPANY:
Name:
_ Applicable
Address:
COUNTYOF syo,i
Address:
The forgoing instrument was acknowledge efore me
City:
Zip: Phone
State:_
City:
Zip: Phone:
State: _
FEE SIMPLE TITLE HOLDER:
Name:
_ of Applicable
BONDING COMPANY:
Name:
_ of Applicable
Address:
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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 Counttyy makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in congict 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 roams 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 i1 ctigFj. If you intend to obtain financing, consult with le or an a porney before
CommencinP.efk or obcbrdin¢ your Notice of Cammpnrpmpnt. //
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Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF sr was
COUNTYOF syo,i
The forgoing instrument was acknowledge,�jry�refore me
The forgoing instrument was acknowledge efore me
this 14TH day of NOVEMBER Ze jQ by
this 14TH day of NOVEMBER Zn I(S by
KYLE MITE \I1111111III
KYLE MITE
Name of person making stl(�A RF' x
Name of person making statement
Personal) Known xx r""'
Personally OR PrrucQlStgn_
Personally Known xx OR Produced Idea(j(jgrdgf)
of Identification omRyer is o��:,.
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Commission No. FF 038050 (Sea11
Commission No. FF 935050
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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