HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
RECEIVED
Building Permit Application JUN 6.3 7019
Planning and Development Services
Permitting Department
Building and Code Regulation Division St, Lucie County
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential X
PERMIT APPLICATION FOR: Roof
PROPOSED IMPROVEMENT LOCATION:
Address: 607 Brack Rd Fort Pierce, FL 34982
Legal Description: HUNT'S S/D BLK B E 25 FT OF LOT 21 AND ALL LOTS 22 AND 23 (0.37 AC) (OR 642-2438: 1528-784)
Property Tax ID #: 3403-701-0049-000-3 Lot No.
Site Plan Name: Block No.
(Project Name: Lisa Bergeron
I' Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
emove existing roof and Replace it with a New Asphalt Shingle Roof System
roduct Approvals: Tamko Shingles: 18355.1 Cobra Exhaust Vent: FL6267-R15
30# Felt: FL12328-R8 (Double Layer)
I; CONSTRUCTION INFORMATION:
j Additional work to be nertormed un er t is permit — c ec a apply:
�HVAC Gas Tank Gas Piping In Shutters ❑ Windows/Doors
❑ Electric ❑ Plumbing Sprinklers ❑ Generator Roof 3/12 Roof pitch
Total Sq. Ft of Construction: 15Sgs Sq.
of First Floor:
Cost of Construction: $ $6,600.00 Utilities: []Sewer Septic Building Height: 20ft
OWNERAESSEE:
CONTRACTOR:
Name Lisa Bergeron
Name: Dee Keihn
Address:607 Brack Rd
Company: PDKRoofing.inc
Address: 1299 SW Biltmore Street
City: Fort Pierce State: FL,
City: Port Saint Lucie State: FL
Zip Code: 34982 Fax:
Phone No. (772)528-0113
Zip Code: 34983 Fax:
E-Mail: PDKRoofing.lnc@gmail.com
Phone No. (772)528-0113
Fill in fee simple Title Holder on next page ( if different
E-Mail: PDKRoofing.lnc@gmail.com
from the Owner listed above)
State or County License: CCC1331408
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
Name:_
Address:
City:
Zip:
NEER: _ Not Applicable
Phon
State
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State: _
Zip: Phone:
BONDING COMPANY: _Not Applicable
Name:
Address:
City:
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 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
com eNcing wort or r�ordi�vour Notice of Commencem"n r, / V
Signature of Own / Lessee/ ractor as Agent for Owner
Signature of Contra t r/License Holder
STATE OF FLORIDA
STATE OF FLO IDA
COUNTY OF
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this 1130,day of 20 0�( by
this !day of 201_ft by
Name of person Dja4dng statement
Name of person ma mg statement
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
U`
(Signature ota
( tgnature of a P
Ida
Commission No.
ALVIN RODRIGUEZ JR
YCOMMISSI�fY'327319
Commission No.
,�. �� ALVIN RODRIGUEZ JR.
2°' '� MYCOMMI�I@I@GG327319
EXPIRES: APR4, 2023EXPIRES:
QB�onded
APR 24, 2023
F
through 1st State Insurance
Bonded through 1st State Insurance
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Rev. 8/2/17