HomeMy WebLinkAboutBuilding Permit Applicaiton 1
ALL APPLICABLE INFCO/ MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 19 -0 2,92_,/
Date: \' XL' \I Permit Number: RECEIVED
rs ;r`_r-- -T? DEC 12 2018
CSOC!'NTY
g .1_ ,C3 R it .n a Permimi ttin Lucie partm
yent
Building Permit Application
Co
1.
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: Roof
,PROPOSED IMPROVEMENT LOCATION: -
Address: 1�3 ID ( o.,i1 Q DQ (19 ,5 ,, R—_ P W.rcE FL
legal Description:
Property Tax ID ft: IF)Q1– \ 1 \ --- an1 – 000 –5 Lot No.
Site Plan Name: N/A Block No.
Project Name: N/A
Setbacks Front N/A Back: N/A Right Side: N/A Left Side: N/A
DETAILED DESCRIPTION OF WORK:
Vv e w OA t2cor off A-1v- 2Jc i +if . sq s,��5\-e \rccic Cwh
oto k> ' w oadl
��-c n w l Cod 01/4-n CI r-e- reo-F.J NA;k-\-\^ 51n t vl k5,
CONSTRUCTION INFORMATION:
Additional work to be erformed under this permit–check all apply:
HVAC Gas Tank LiGas Piping —Shutters �� windows/Doors
ElElectric ❑ Plumbing nSprinklers 0 Generator Roof ?712 Roof pitch
Total Sq. Ft of Construction: ti-SOD / i * S . Ft.of First Floor: N/A
Cost of Construction:$ ly l/L}OD, 00 Utilities: Sewer EllSepticBuilding Height: N/A
OWNER/LESSEE: CONTRACTOR: '
Name Hr4-� 1�Qjv-orDe ri Name: . Christopher Collins
Address: ( j)P C A U e :p Lo,r : Collins Roofing Inc.
os Company:
Ca � � P Y
City.: ---V--P1 c iri^e State: Address:°"P.O: Box 12867 ...."
Zip Code: Fax: N/A City: Ft. Pierce State: FL
Phone No. N/A Zip Code: 34979 Fax: 772489-6505
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: leNot Applicable MORTGAGE COMPANY: le Not Applicable
Name: Name:
Address: Address:
City: State: City: Ft.Pierce State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: leNot Applicable BONDING COMPANY: leNot 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 b ' sing permit applications are exempt from undergoing a full conc - . review: room additions,
accessory s - cture• swi • : sools,fences,walls,signs,screen rooms and a •essory us:s to another •.n-reside itr 'al use
WAR G TO 0 ER:Your ailure to Record a Notice of Comme P cement ma esult' your paying tw ce for
improvement Y. your prope y. A Notice of Commencement ' ust be r-••reed :nd posted in the jobsite
before the f•: ,spec-Col.►. If ou intend to obtain financing, •onsult w'i`le . ..r or an at ney b: ore
co. menci,•S irk o - e rd' g your Notice of Commence -nt.
'ad
S 4;j;iJ
re of Owner/Lessee/Contractor as Agent for Owner Signatu • Contr. •r/Lit older •
STATE OF FLORIDA c // STATE OF FLORIDA I
COUNTY OF 5- LC< )r COUNTY OF 5'-f, buei- c
The for oing instrument was acknowledged before me The for oing instrument as acknowledged before me
this Jday of D-ec ,20(rby this i'2 day of VCC ,20 (sr by
/!'rte ill i t)Lip r 1o1�r- :,. �
--', "4---A.„,golf----
t 4,,,- c,14,,4,,,- 14,,
Name .4�pers•/making statement V1�'tName of p/son ,/king statement
Personally K iwn OR Produced Identification A. Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced FLOC— Produced ruf9/i
ice_-'
(Si; / .: _
ur: . Notary Pub ��I!"tf�F1'✓3Ff� (Si:l fir
(Sir of Notary Public-State of Florida)
,o� �P� 'OSE TAPIA /
`= Notar Public-State of Florida ,•........••.,
'? ,.,•; •; Y�� ;ti C�,,1p E TAPIA
C. mission No. �� q; CoihAftl�n#GG 215487 C•mmission No. :c = $$
' �, „ �1 Notar� fd-State of Florida
?o� °;'` My Comm.Expires May 8,2022 _ '�, i o" Commission#GG 215487
Bonded through National Notary Assn. • oe�..., My Comm.Expires May 8,2022
_ _ __ e e flnndPdmp.upthroe°)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17