HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED \ 1
Date: Permit Number:
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Permit Application 9 ?019
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Planning and Development Services ST. Lucie County, Permitting
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 — g
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Address: 2812 Jefferson Parkway, Ft. Pierce, FL
Legal Description: San Lucie Plaza S/D-Unit One BLK 58 Lots 12 and 13-Less to FL DOT as in OR
1041-2050 and all lots 28 and 29 (Map 14/29S)(OR 580-16173904-1202)
Property Tax ID#: 1428-702-1293-000-9 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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ol 195
Remove existin shingle d install n w shingle roof
e� roof anz.1 rid Hymen
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Additionalwor to e e orme under this permit—check a appy:
❑HVAC -Gas Tank F_]Gas Piping _Shutters ❑Windows/Doors
01 Electric ❑Plumbing []Sprinklers ❑Generator ❑Roof Roof pitch.
Total Sq. Ft of Construction: 4780 Scl.Ft.of First Floor:
Cost of Construction:$ 15750 Utilities: Sewer❑Septic Building Height: 8'
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Name Darrell & Lisa Crum Name: Jamie Cisco
Address: 2280 Johnston Rd Company: Sunshine Roofing LLC
city: Ft. Pierce, State: FL Address: PO Box 1083
Zip Code: 34951 Fax: City: Palm City State: FL
Phone No. 772-370-2538 Zip Code: 34991 Fax:
E-Mail: Phone No. 772-260-8195
Fill in fee simple Title Holder on next page(if different E-Mail: sunshineroofingllc@gmail.com
from the Owner listed above) State or County License: CCC1327796
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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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
befor a st inspe i . If you intend to obtain financing,consult with lender or an attorney before
com encin wor o re rding your Notice of Commencement.
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Signatu f Owner/Lessee/Contractor as Agent for Owner Signatu of Contractor/License Holder
STATE OF FL O I 4A STATE OF FLORIDA
COUNTY OF -I— t—UC I �'� COUNTY OF St.Lucie
The ring instr ent was acknowled before me The r oing instrum was acknowledge efore me
this�day of Qvtu ct20LL by this day of�, �—�J 20 by
�ckcrel( ��u `gvn'k, C ► csCo
Name of person aking statement Name of person making statement
Personally Known OR Produced Identification Personally Known X OR Produced Identification
Type of Identification Type of Identification
Produced Produced
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(Sign ture of Not rPu 'i - tat f FI ri1a (Signature of Not ry ublic-State of FI rida)
n a0. 2&o Notary Pubic tat of Floridaas�a�
d" 2 ; Marilyn Kluej�EI + o�y Nvr Notary Pu �� J, of Florida +
Commission No. (e ° ul f1 t ommissidd1l13017, Commission No. _` k w f{
Ex ues 0 612 8/201 9 q w+?z? P Marilyn I<luegel
(+F FL P - aka.Y qv My commission FF 230179
fb t+tri. Expires 06,128/2019
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE -
COMPLETED
Rev.8/2/17