HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �`• ry
Date: Permit Number:
RECEIVED
- -
Building Permit Application JAN 16 2019
Planning and Development Services ST. Lucie County, Per Itting
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
'PROPOS`ED'INIPROVEMENTlOCATIOM
Address: 4691 Jorgensen Rd, Fort Pierce, FL 34981
Legal Description: WHITE CITY S/D 05 36 40 S 150 FTOF LOT 69 AND W 420 FT OF E 440 FT OF S 150 FT OF N 660 FT OF NE1/4 OF NW 1/4 OF
NE 1/4=LESS N 130 FT OF E 335.85-LESS S 10 FT OF E 10 FT-(1.20 AC)(MAP 34/05N)(OR 590-715;2629-1715; 3258-1931)
Property Tax ID#: 3403-502-0128-200-2 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side.: Left Side:
DETAILEp. DESCRIPTION 0 WORK: -`
Reroof- Remove existing roof covering, dry in with self adhering underlayment and install new asphalt
shingles.
CONSTRUCl`ION`LNFORMATIO'N -
Additiona I work to be neffo—rmed under this permit–check all appy:
HVAC Gas Tank ❑Gas Piping _Shutters ❑Windows/Doors
11 Electric ❑Plumbing []Sprinklers E Generator rI Roof Roof pitch
Total Sq. Ft of Construction: 1380 sq ft Sq- Ft.of First Floor:
Cost of Construction:$ 6,285 Utilities:Sewer ElSeptic Building Height:
01NNER/LESSEE ; ; CONTRACTOR: .`
Name Lyman W Johnson&Joan K Johnson Name: Michael Miller
Address:4691 Jorgensen Rd Company: Trade Winds Roofing, Inc
City: Fort Pierce State:FL Address: P.O Box 13208
Zip Code: 34981 Fax: City: Fort Pierce State:FL
Phone No.772-461-4568 Zip Code: 34979 Fax: 772-466-9725
E-Mail: Phone No. 772-466-9420
Fill in fee simple Title Holder on next page(if different E-Mail: Mike@tradewindsroofing.com
from the Owner listed above) State or County License: CC C057399
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LI{ N LAW INFORMATION
-,
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
commenci w or recording our Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of-Contractor/License Holder
STATE OF FLCOUNTY OF ORIDA fs� VuC COUNTY OF STATE OF FLORIDA�S T UA
Gl
The fo going inst ument was acknowledge efore me The forgoing instr ment was acknowledged before me
this day of�Q Y)LA C(��I 201/ this 1 l(� day of 20 by
iM I / T�i
Name of person aking statement Name of p rson aking statement
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Pro ced Pro uced
Vn Lu a
(Signature of Notary Public-S e of Florida eGc(a L ne Wilkin (Si nature of Notary Public-St f Florida
0, 141.
y. FeLia Lyne Wilkin
N TARY PUBLIC q%MY PUBLIC
Commission No. 9YATE OF FLORIDA Commission No. -TSTA OF FLORIDA
Comm#GG103860 Comm#GG103860
0
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17