HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFOa MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: `t��l11 Permit Number:
•£ RECEIVED
Building Permit Applicatio SEP
Planning and Development Services
Building and Code Regulation Division ST. Lucie County, Permitting
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT TYPE: reroof shingles
PROPOSED IM'P,ROVEMENT.LOCATIQN: . .
Address: 6018 travelers way ft pierce,fi 34982
Property Tax ID#: 3410-503-0103-000-4 Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK ;.
reroof shingles to shingles peel and stick underlayment
CONSTRUCTION'INFORMATI `
Additional work to be performed under this permit—check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator _Roof 5 Pitch
Total Sq. Ft of Construction: 3000 Sq. Ft.of First Floor:
Cost of Construction:$ 10500 Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE, CONTRACTOR.
Name norma hammond Name:roland wiley
Address:6018 travelers way Company:shoreline roofing
City: ft pierce State:_ Address:1973 sw glendale st
Zip Code: 34982 Fax: City: Port st lucie State:fl
_ Phone No. Zip Code: 34987 Fax:
E-Mail: Phone No 772-260-9565
Fill in fee simple Title Holder on next page(if different E-Mail shorelineroofing@yahoo.com
from the Owner listed above) State or County License CCC1331170
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
If value of HVAC is$7,500 or more,a RECORDED Notice of Commencement is required.
SUPPLE_MENTAL£CONSTRUCTION LIEN LAW INFORMATION §= t
.-<
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: 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 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 JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR TTORNEY BEFORE RECO RDINGrY E OF COMMENCEMENT:'
Signa ure of Owner/Lessee/Contractor as 4gent for Owner ignature of Contractor/Licerjse44,QLde,r
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF !0r. COUNTY OF 4,3r-l.yr�@
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this to day of 5,te4 20% by this day of 5e 20_W by
Name of person making sta ement. Name of person making stat ment.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identi ication Type of Identification
Produced 'T ID-L Produced 'F
(Signature of Notafl Public-State of FloriEG � (Signature of Notary ublic-State of Flori
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REVIEWS FRONT '•."gF,o,. G SUPERVISOR PLANS VEGETATI 1' TtJRTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
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