HomeMy WebLinkAboutHembree (Shed) - AppALL 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 APP LCATION FOR: Roof
PROPOSED IMPROVEMENT LOCATION:
Address: 4916 PALED PINES CIRCLE
Legal Description: HOLIDAY PINES S/D-PHASEII-B-LOT 299
Property Tax ID #: 1312-801-0102-000-5 Lot No.
Site Plan Name: Block No.
Project Name: HEMBREE/REROOF SHED
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
TEAR OFF SHINGLE, RENAIL DECK. INSTALL NEW OWENS CORNING DURATION SHINGLE
(FL# 10674.1) ROOF SYSTEM OVER 30#FELT UNDERLAYMENT .
CONSTRUCTION INFORMATION:
Add rtiona workto orme un ert Is perm it—c ec a appy:
I,e_gelr
LJ Gas Tank ❑Gas Piping _Shutters 0I�Windows/Doors
Ij❑_�IHVAC
13 Electric OPlumbing 05prinklers ❑Generator Lr (Roof 5/12 Roof pitch
Total Sq. Ft of Construction: 200 SaII—. F�t.I of First Floor: 150
Cost of Construction:$ 800 Utilities:In Sewer ElSeptic Building Height: 1 STORY
OWNER/LESSEE: CONTRACTOR:
Name JOY H SKELTON
Name: KYLE WHITE
Address: 4916 PALED PINES CIRCLE
Company: JA. TAYLOR ROOFING INC
City: FORT PIERCE State: FL
Address: 302 MELTON DRIVE
Zip Code: 34951 Fax:
City: FORT PIERCE State: FL
Phone No. 770.460.5020
Zip Code: 34982 Fax: 772-468-8397
E -Mail:
Phone No. 772-466-4040
FIII in fee simple Title Holder on next page ( if different
E -Mail: NADINE@JATAYLORROOFING.COM
State or County License: CCC1325895
from the Owner listed above)
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
Signature df Contra r/License Holder
DESIGNER/ENGINEER:
Name:
-Not Applicable
T
MORTGAGE COMPANY:
Name:
-,---Not Applicable
Address:
The forgoing instrument was acknowledged before me
Address:
this 151 day of m— 20/7 by
City:
Zip: Phone
State:_
City:
Zip: Phone:
State: _
FEE SIMPLE TITLE HOLDER:
Name:
_,—Not Applicable
BONDING COMPANY:
Name:
Not Applicable
Address:
Produced a RMyCMIMISSIONp GG
Address:
anon EXPIRES:Maytd, 20
City:
City:
(Signature of Nota Public -State lodd, )
Zip: Phone:
Commission No. Go 063070 (Sea])
Zip: Phone:
FRONT
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 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 Iobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
ccurnmencing work or recording our Notice of Commencement.
Signature of Oviiier/Lessee/Contractor as Agent for Owner
Signature df Contra r/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF aTWGE
COUNTY OF .1.1E
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this — day of unxcH 20L7 by
this 151 day of m— 20/7 by
KYLE WHITE
KYLE WHRE
Name of person making statement
Name of person making statement
Personally Known xx OR Produced Identification
Personally Known OR Produced�,�?�ntification
Type of Identification �pv°!'4T VALERIUMLGA1r
_
Type of ldentifcation .$�:. ft VMERIEJOELG
Produced�n�. MY COMMISSION #G00E127
Produced a RMyCMIMISSIONp GG
F7T RES. May 14.2021
? de
orn oMatl Trxua+IlAal Nday
anon EXPIRES:Maytd, 20
---`-1
(Signature of Notary Public- Stateloll Florida I
(Signature of Nota Public -State lodd, )
Commission No. GG aaazro (Seal)
Commission No. Go 063070 (Sea])
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17