HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
� Permit N m er. /� 0 9 �
•
-ED
RECEI
019
Building Permit Applicati n SEP 2 3 2
Planning and Development Services Permitting Department
Building and Code-Regulation Division St. LU C I e COU FL
2300 Virginia Avenue, Fort Pierce FL 34982 yi
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residentia
PERMIT APPLICATION FOR: Roof O'U•Ur
PROPOSED IMPROVEMENT LOCATION:
Address:117 S `tZc'S , .� �CQ R,
Legal Description:
Property Tax ID#: 7414 1'" Lot No.
Site Plan Name: N/A Block No.
Project Name: N/A
Setbacks Front N/A Back: N/A Right Side: N/A Left Side: N/A
[:DETAILED DESCRIPTION OF WORK:
vN P, W k.1\ �DZ d.01Y0_. r6&p o\jz ' cc\ rtA 6 h .OE
CONSTRUCTION INFORMATION•.
Additional workto eperformed" d under this permit—c ec a appy:
HVAC Gas Tank E]Gas Piping _Shutters Q Windows/Doors
Electric 0 Plumbing O Sprinklers E]Generator Roof- 12 Roof pitch
Total Sq. Ft of Construction: .I S . Ft.of First Floor: N/A
Cost of Construction:$ 5 a"1,5 .Oc� Utilities:Sewer Septic Building Height: N/A
OWNER/LES-SEE ... ., L CONTRACT09:,
� 1 i C f ,
i C.nsto, her Colli
Name
an
Address: �2G Compy:, Collins Roofing Inc.
IS ' `P:O..
Box;12867 State: Address:.
Zip Code: Fax: N/A City: "Ft.--Pierce _ State: FIL
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 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 c curre cy r ' . m additions,
accessory str res,s immi Is,fences,walls,signs,screen rooms a accessor es to anothe non-residential use
WARN GZTn
R:Your fai ure to Record a Notice of Co encem t result in yo r paying twice for
impr vemr prliny�qiwur
y A Notice of Commence nt mus r rded and po ted on the jobsite
be ore the ctiointend to obtain finan ng, con w' I nder an a torney before
mmencir Notice of Comme cement
Sign e L Contractor as Agent for Owner Si of66drg-c-to-77ficense Holder
STATE OF FLORIDA STATE OF FLORID
COUNTY OF S -21 Z,y Gi 2 CC>un'{ COUNTY OF �
The forgoing instrument�was acknowledged before me The for oing instru ent was acknowledged before me
this 0 3day of S2 o-tCuy� r ,20LE by this day of!J 20j`(by
Name of person rr�3lci> g statement Name o person making statement
Personally Knowny OR.Produced Identification Personally Known ✓OR Produced Identification
Type of Identification Type of Identification
Produced Produced
q&A- LA_e'�' _ _ a -
(Signature tary Public-State of Florida) (Signature fo ary Public14-6 .0-
�P�'•••. CATHY J ROBERTS
j�'` '�' r Pu is-State of Florida
Commission No.6Commission No. :�on
H GG 316785
CATHY J ROBDFi'd
of 0 My Comm.Expires may 10,2023
Notary Public-StatBonded through National Notary Assn.
Commission#GY
My Em 2023
Bon ed throw h National
REVIEWS F OR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17