HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE� r- ACCEPTED
Date: ' /� c Permit Number: 1q07
" �
Building Permit Application 'p<;n
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
PERMIT APPLICATION FOR: Roof
PROPOSED-IMPROVEMENT-LOCATION:' Q. r. = -
Address: 015 ��nnao D- T1e�- '� y
ki
Legal Description:. Ind to Raver E is - LAY\I± 0 NY- 3 S30
Property Tax lD#: 3�f-02-1�10- C?s�5 —^1 Lot No. 30
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
F6ETAILEDDESCR'IPTION'6F,WORK:
�►v W �� teour 6k0VN K it `JNt4
dlta, \ , r,Lv ask -1D cv-wr-vor a. Suon&an wow rLs(5tgn
rla o�hdl kh5J&-A a YVl!.w 5 t0%%YtAe_ r_0CX .
CONSTRUCTION INFORMATION:
Additional work to e e orme under this permit-check a appy:
❑HVAC D Gas Tank Gas Piping _Shutters Windows Doors
❑ p g ❑Windows/
Doors
❑ Plumbing Sprinklers ❑Generator F'-/] Roof I Roof pitch
Total Sq. Ft of Construction: �� • 33 S . Ft.of First Floor: N/A
Cost of Construction:$ ��id Utilities Septic Septic Building Height: N/A
OWNER/LESSEE: CONTRACTOR:
Name C Name: Christopher Collins
Address: Company: Collins Roofing Inc.
City: 14-?1.0jr(P State: Address: P.O. Box 12867
Zip Code: 31•,-9 92 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: _Not Applicable
Name: Name:
Address: Address:
City: State: City: Ft.Pierce State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: _Not 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 County Amendments.
The following building permit applications are exempt from undergoing a fZnh
revi • oom additions,
accessory stru es,swi ng po fences,walls,signs,screen rooms es to anoth non-residential use
WAR G TO NER:Your)failre to Record a Notice of C mey result in yo r paying twice for
im oveme t your propA Notice of Commenc ent rdedandpo tedonthejobsite
fore t it t nspecti fintend to obtain fina cing, conder n ttorney before
comm i ork o e rdour Notice of Comm ncemen
Si re of Owner/Lessee/Contractor as Agent for Owner ignature of Co r/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF S+ Lis C_ � COUNTY OF
The forgoing instru�r ,e at was acknowledg d efore me The forgoing instrum �'as acknowledged before me
this, day of J �20��by this day of c� ty y ,20L� by
�`1►-Ism , C/S /g
Name of person making statement Name of person making statement
Personally Known fOR Produced Identification Personally Known,OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Signature �1
N - '�'E+'�f�'I (Signature Nota P ic,Statl3o lar'
��• �eL.: CATHY J 4 ERTS v'a" CATHY J ROBERTS
? `,1 Q1 Notar Public-5 . rR.
�..'; Y y�t�AlsFlorida Commission No. _°:"1 Y ���f
Commission No. �' mission k 785 1 r:. Notary Public lorida
or ommission ff GG 31 B785
My Comm.Expires May 10,2023 r '''�o, ` My Comm.Expires May 10,2023
Bonded through National Notary Assn. Bonded through National Notary Assn.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17