HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED MTOLAI-l
Date: PermitNumber:
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 x
PERMIT, TYPE: Reroof
Address: 4950 Dunn Rd, Ft. Pierce, FL 34981
Property Tax ID #: 3403-502-0156-300-8
Site Plan Name:
Project Name:
Remove
ilnstall dimensional shingles. C�- r rJ
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Additional work to be performed under this permit- check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters
Electric _ Plumbing _ Sprinklers _ Generator
Total'Sq. Ft of Construction: 700'
Cost of Construction: 00
Sq.. Ft. of First Floor: _
Utilities: —Sewer _Septic
Lot No.
Block No.
_ Windows/Doors
Roof 3/12 Pitch
Building Height: 1
OWNER/LESSEE0
CONTRACTOR a
NameJohn Kinley
Name:David Packard
Address:4950 Dunn Rd.
Company: Packard Roofing & Waterproofing, Inc.
City: Ft. Pierce FL State: _
Address:2182 NW Reserve Park Trace
Zip Code: 34981 Fax:
City: Port St. Lucie, State: FL
Phone N6.772-461-3696
Zip Code: 34986 Fax: 772-468-9978
E-Mail:
Phone N0772-468-3723
Fill in fee simple Title Holder on next page ( if different
E-Mailssmith@packardroofing.com
from the Owner listed above)
State or County License CCCA1 7517
er vdiue or construction is ;Pcouu or more, a KtcUKutu Notice of commencement is required.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL
CONSTRUCT
ION Lf�N LAW INEORIVIATl01
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DESIGNER/ENGINEER: _
Not Applicable
MORTGAGE COMPANY:
Not Applicable
Name:
Name:
Address:
Address:
City: i
State:
City:
State:
Zip: i Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Not Applicable
BONDING COMPANY: _
t Applicable
Name: i
Name:
Address::
Address:
City: I
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 Cob ;nty 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 l 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 i FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE-C'F FLORIDA
COUNTY OF 5t. ot-�-F._
STATE OF FLORIDA
COUNTY OF t WLNf-
The for Bgi�ng instrument was acknowledge before me
this I+'+5ay of .TJlu 201 by
The forggmg instrument was acknowledged before me
this ! '"bay of s�lU , 20111 by
�a►s►d P�t��rc)
b��r� �a
Name of person making statement.
Name of person making statement.
Personally Known ✓ OR Produced Identification
Personally Known ----V-/—OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature of N ice'
STEPHANIE P. SMITH
.a �- Notary Public -S of orida
Commission No _ Commission w 8�g3y 2a
(Signature of
T STEPHANIEP.SMITH
:a .^'; Notary Public - State lori
Commission ; • • •? fission 9 GG 1 %
My Comm: Expires Sep 2, 2021
.a ae" My Comm. Expires Sep 2, 2021
REVIEWS FRONT
SUPERVISOR
PLANS
VEGETATION
MANGROVE
ZONING
SEATURTLE
COUNTER
REVIEW
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DATE
RECEIVED
DATE
COMPLETED
Rev. Z/7/19