HomeMy WebLinkAboutBuilding Permitg Application ALL APPLICABLE INFO MUST BE COMPUTED FOR APPLICATION TO BE ACCEPTED(110
Date: ,r'1-3/4"19 Permit Number: l Cj V Li-O a7)
gim-t-_p.-C _,_ RECEIVED
COUNTY '.
.o: APR 0 3 1019
Building Permit Application
permitting pepartmon4
Planning and Development Services St.Luce County i
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: ,W,. ._ - -, E .. ,: . . _
Address: 29 f5 3c h r t ec C'-'. '\ FL 1
Legal Description: ScolOorw\CL C1 - ?kook-kW) ii3Ny..3k 1_&- Al
Property TaxIDit: SI-115-102.-0 2.23-000-8 Lot No. 11
Site Plan Name: N/A Block No. 3�
Project Name: N/A
Setbacks Front N/A - Back: N/A Right Side: N/A Left Side: N/A
DETAILED DESCRIPTION.OF,WORK=: -
- e0Jr -kiAi- too n r a aF ok - c� Y'2 roo w tkAk 56f ad(ales t vt
v1/4,vA d.,r 1 o�w..c o r4 o &k 64-45.
CONSTRUCTION INFORMATION:
Additional work to b _performed under this permit-check all ;hat apply:
LIHVACWindows/Doors
_Gas Tank ,Gas Piping —Shutters 11
❑Electric ❑ Plumbing Sprinklers ❑Generator I/Roof 3/Z , Roof pitch
Total Sq. Ft of Construction: ,gletir 20 `t' S . Ft.of First Floor: N/A
Cost of Construction:$ 3i,50•Oa' Utilities: I Sewer 0 Septic Building Height: N/A
OWNER/LESSEE CONTRACTOR:
Names/401/.�1 0C�4�-_1 CO" Name: Christopher Collins
� M�►U C�
Address: 1402_ PoorlLPlc,.cac, Ave, Company: Collins Roofing Inc.
City: Cir (ll� E.2q �� State: 143 Address: . P.O. Box 12867
Zip Code: 1120 Fax: N/A City: Ft. Pierce ,State: FL
Phone No. N/A 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: " le Applicable
Name: Name:
Address: Address:
City: State: City: Ft.Pierce State:
Zip: Phone Zip: _ Phone:
FEE SIMPLE TITLE HOLDER: VeNot Applicable BONDING COMPANY: VNot 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 my Ame•dmen
The following building perm' __• 'cations are exempt from undergoing a fu concurrency r-,I=w:room addi ions,
accessory s . - s ming poo - fences,walls,signs,screen rooms d accessory - es to ,,nother non- -sidential use
WA: 1 ING TO e- Il NER:Your fail re to Record a Notice of Co menceme• • -y res It in your •vying twice for
i .rovemen�, o our p •pert,. A Notice of Commence ent must •- re ford- and post:d on the jobsite
.-fore the !,st ii spe • on. If ou intend to obtain finan 'ng, cons J, wit, le .er . a orney before
ommen 'y%! w.rk o •ecor.'ng your Notice of Comme cement,/
// 1/Lessee/Contractor
///7,,
•i: , 'e of 0 as Agent for Owner Sig �':f�of ontr. : License Holder
STATE OF FLORIDA ( f ` STATE OF FLORIDA ( t_ JAN
�
,A.r•
COUNTY OF `Y-LU c-- COUNTY OF �1
The forgoing instru -nt wa>; •cknowledggd before me The forgoing instrJent w� acknowledge before me
this 1 day of a'' IAA 2019 by this I day of ( / /1,.i ,20 11 by
�y ,IS ( hLo �,.
Name of pers n aking statement Name of perso- making statement
Personally Known • OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Producedif Produced /
.
/
(Signa .f r.tary P blic-State of Florida ) (Signat IA �'9 •ublic- ;-..
11'*°"16"'"'"11661161611641&°146411/"6: ( " CASEY FRENCH
Commission No (' / a ", ; .: dr rMilc—FRENCH ; Commission No�I(0 �(,e" ;o No P is—State of Florida
Not y c—State of Florida MI-Milan#GG 167258
4 :• Commission#GG 167258 ,'4o 7�,,o`:; My Comm.Expires Dec 11,2021
•-•:!•:„./ t o. Comm.Expires Dec 11,2021 P 1','
��p:, My p ,,, Bonded through Natrona!Nola,y Assn. `
;:•' Bonded throng Nalional Notary Assn
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17