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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: `b'+ �.'l Permit Number:
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Building Permit Appy` siori*
Planning and Development Services Pco�°''i,�
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMITTYPE: � (601�
,PROPOSED IMPROVEMENT LOCATION; F,
Address: 5907 Alexandria cir ft pierce fl 34982
Property Tax ID#- 3410-503=0188-000-3 Lot No.
Site Plan Name: Block No.
Project Name:
d
DETAILED DESCRIPTION OF WORK:
Reroof shingles to shingles peel and stick underlayment
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit—check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters Windows/Doors
_Electric _Plumbing _Sprinklers _Generator V Roof 5 Pitch
Total Sq. Ft of Construction. 3000 Sq. Ft.of First Floor:
Cost of Construction:$ 10500 Utilities: —Sewer _Septic Building Height:
C+WNER/LESSEE: CONTRACTOR:
Name Robert Alacantaro Name:roland wiley
Address:5907 Alexandria cir Company:shorelineroofing
City: ft pierce State: I Address:1973 sw Glendale st
Zip Code: 34982 Fax: City: port st lucie State:fl!J
Phone No. Zip Code: 34987 Fax:
E-Mail: Phone No772-260-9565
Fill in fee simple Title Holder on next page(if different E-Mail shorelineroofing@yahoo.com
from the Owner listed above) State or County LicenseCCC1331170
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
If value of HVAC is$7,500 orlmore,a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CONSTRUCTION LIEN LAW. IN
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLEHOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtaina' 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
FOSTEP ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YP'VFAENPfR OR AN ATTORNEY BEFORE RECORDING MUR NOTIC OF COM ENCE ENT."
Sign ture o Owner/Lessee/ContraAGLaALAgent for Owner Signature of Contractor/License Holder 1
STATE OF FLORIDA STATE'OF FLORIDA
COUNTY COU OF OUNTYF
O
The forgoing instrument vps acknowledged before me The forgoing instrume was acknowledged before me
this .[Sway of 201this ay of 20� by
Name of person Mking statement. U of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced / � Produced
(Signature of Notary ic-State of Florida} (Signature k Notary Public- tate of Florida )
Commi n ,�,, EN VAUGHMeal) Co ;� ""'gyp. ELLEN Voi iGHN al)
4PpY P„B�i
1=0 ;state of Fiori a-Notary P6511C ;:° _State of Florida-Notary Public
*= Commission # GG 270079 *= Commission #GG 2 Inn
�9�OFf y ��.,;���°°°�` Y ommis ion Expires
RE-VIE �"""`' ctob r 22, 2022 .
UPERVISOR P er � TL MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.
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