HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: �ti��� �� Permit Number:
RECEIVED
Building Permit Applicatio(RP
Nov 21 2018
Planning and Development Services
Building and Code Regulation Division Lucie County; Perml t1no
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial idential
PERMIT APPLICATION FOR: Roof, z `
PROPOSED IMPROVEMENT LOCATION:
Address: 544 75--opic W ISIPS ,Cin PSL R_
Legal Description:T'rnf)lCnA ur)* C —r)l
Property Tax ID#: .*N'10 Lot No.
Site Plan Name: NIA Block No.
Project Name: N/A
Setbacks Front N/A Back: NIA Right Side: N/A Left Side: N/A
DETAILED DESCRIPTION OF WORK: ,
VJ a v t t 14 -t-2ae- o�+*Vtf- .est t6 c s V'\\v\d e_ rcx6� ar,,r.A \v\ s al a n ew
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CONSTRUCTION INFORMATION:
Additional work to.be nertormed under this permit—check all appy:
HVAC Gas Tank ❑Gas Piping _Shutters ❑Windows/Doors
Electric ❑ Plumbing ❑Sprinklers Generator [4� Roof oof pitch
Total Sq. Ft of Construction: S . Ft.of First Floor: NIA
Cost of Construction:$ LP, 9MGQ Utilities:Sewer Septic, Building Height: N/A
OV1/N ER/LESSEE: CONTRACTOR: . .
Name t Name: Christopher Collins
Address: it Company: Collins Roofing Inc.
City: WY 4 e`�`�_(�.cle. State: Address: P.O. Box 12867
Zip Code: c;L 9Z Fax: N/A City: Ft. Pierce State: FL
Phone No. NIA 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: collinsroofinginc@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: Ft.Pierce State.
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: _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 struc wimming pools,fences,walls,signs,screen rooms and acc ry uses to another non-residential use
WARN TO O :Your ilure to Record a Notice of Com ncement result in y r paying twice for
impr vements y ur prope . A Notice of Commence nt must be c rded and po ted on the jobsite
be ore the fi in ection. y u intend to obtain finan ' g, consult I nder or a orney before
mmenci or r —rd* g your Notice of Comme cement.
gn r Ow ss, ontractor as Agent for Owner o ontr or/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF �—l_LuGP-e COUNTY OF S - ���
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of JJW, l ,20_Lt by this-IL day of y(Aly 201 by
Name of person making statement Name of p son making statement
Personally Known OR Produced Identification�— Personally Known OR Produced Identification
Type of Identification Type of Identificati�C n
Produced � L— Produced 'V C
(Sig ur f Notary u t► "� ,a'e o ori APIA (Signaty of aryPubl' - ��rt3 lG JOSETAPIA
Notary Public-State of Florida No, State of Florida
<_ 1
Commission No. Commiss(&rMOG215487 Commission No. �° Com issiorfpGG215487
of y Comm.Expires May 8,2022 `?�tedMy Comm.Expires May 6,2022
Bonded through National Notary Assn. Banded through National Notary Assn,
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17