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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
_ RECEIV D l
•--- AUG 1 4 ? E9
fBuilding Permit Appli.catio�n i
Planning and Development Services ST. Lucie County, Perrnitting
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 IM;PROVEMENT:LOCATION;
Address: 3460 StAn Y'1 SC 61 VJFoYt J?x4 FL
Legal Description: �jLAI(� r�sZ �nV1/�P SOEE6 5 9 sw_ E..&'-i
Property Tax lD#: a'1a�'1�a -aay"1 "add s Lot No.
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.`DE'SCRIPTION'OFWORK .. 'F
-tear � J�- .e_x sr-1 shNvl r0a-F d �
W V')11\. _ C -}L..` P\�wC10 ate;--- -
N a,k Ck-f-e . cif to Gu�v'�-� Cod e, ave � h�stu� u no�lcx la�,er�alon�
w�� a S� Im�al r0o�i�
CONST,R�UCTION.INFORMATION:
r
Additional work toe performed under this permit—c ec a appy:
HVAC Ei Gas Tank E]Gas Piping Shutters a Windows/Doors
Electric ❑ Plumbing Sprinklers Generator Roof 'T I_ Roof pitch
Total Sq. Ft of Construction: S . Ft. of First Floor: N/A
Cost of Construction:$ 11 40f).y® Utilities:cn Sewer ElSeptic Building Height: N/A
OWNER/LESSEE CONTRACTOR:'
Name Vo,r\
CL Name: Christopher Collins
Address: nn-�vv Company: Collins Roofing Inc.
City:a State: Address: P.O. Box 12867
Zip Code: 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.
1
SUPPLEMENTAL.CONSTR,UCTION 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 thepermit 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,
accessor ructur ng pools,fences,walls,signs,screen rooms;a - e ' ry us another non-residential use
WA ING T NER:Yo failure to Record a Notice of C m may resul 'n your paying twice for
i rover t your op rty.A Notice of Commenc enecorded a d posted on the jobsite
efore t rst ' sp n. I you intend to obtain fin , ting, wi h le or an attorney before
comme w r r cor n our Notice of Com enceme
Sigma - r—L ssee%Contractor as"Agent-for-Owner 5igrnre_of=Contractor/License�N_'old_'e"r
STATE OF FLORIDA (( � � STATE OF FLORIDA
COUNTY OF � l.il�(w� '� COUNTY OF
The for oing instru nt was acknowledgPd me The for oing instr ent was acknowledgeefore me
thisj�day of 201 by this day of 20!7 by
0J)r(1
Name of person ing statement Name of persorf,v�aking statement
Personally Known OR Produced Identification Personally Known ✓✓ OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Signa re to tic- t of I ida ( gnatu o of ubli S
CASEYFRENCH ;••'Niviy;'•,, CASEY FRENCH
W'' �` " � Rublic—StateoGFlorida
Commission No. R,1��2 (dSPl�lpublic—State of Florida Commission No. � ��.`��o�mlrfrission#GG 167258
Commission#GG 167258
M Comm.Ex ires Dec 11,2021 "A +fid+P�`=My Comm.Expires Dec 11,2021 y p °"`:;•'
Bonded Through National NolaryAssn. Bonded through National NolaryAssn.
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17