HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED u
Date: `���d�\� Permit Number:
. ! ` RECEIVED
Building Permit Application' OCT 1
2019
Planning and Development Services
Building and Code Regulation'Division ST. Lucie County, Pe miffing
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 -Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: Roof S�
PROPOSED.I.MPROVEMENT LOCATION:
Address: L 40 Ma a a�(���
Legal Description: a1 v,n gy'O\J SP ID P231 Oct_(' LCA_ (ri
Property Tax ID#: 3�1Q �C��=Qn?3�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:
W G W Ili `�'eo►,rr Cr� `�. •e>Ct�h 5ht � row dpwr, -� '�1n+t PIS w O�nl�
n0L\1 DK +(> CSS, 115 t1 0+. 51r��u.�a�MAM+ c_v"(A I'n SMSA C'vW-Y'J s&hie
rbo�
CONSTRUCTION INFORMATION
Additional work toa nertormed under this permit—check a appy:
F]HVAC Gas Tank Gas Piping _Shutters Q Windows/Doors
11 Electric 0 Plumbing Sprinklers Generator 21 Roof l2 Roof pitch
Total Sq. Ft of Construction: Z / S . Ft.of First Floor. N/A
Cost of Construction:$_��-� 30•�Q Utilities:cn Sewer OSeptic Building Height: N/A
:OWN'ER/LESSEE CONTRACTOR:
Name J j jnd Q \1 An Do,,r+ Name: Christopher Collins
Address: Lpl k� Mpdo4o n (* Company: Collins Roofing Inc.
City: R.P1gja.2. State:VC, Address: P.O. Box 12867
Zip Code: '-- 7— 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 full concurrency r -e1ro- additions,
accessory es,swimming pools,fences,walls,signs,screen rooms access es to another n-residential use
W ING TO ER:Yo failure to Record a Notice of C mencem t ay result in your aying twice for
i proveme t your prop rty.A Notice of Commenc ent mus orded and post don the jobsite
efore th st nspect1pn. you intend to obtain fina cing, cons w' lender or an att rney before
comme ork o eco ing your Notice of Com ncemen
I O r/Lessee/Contractor as Agent for Owner e n actor icense Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF .54- COUNTY OF 54—
The
4--The forgoing instrument was acknowledged before me The forgoing instrument wa acknowledged before me
this q day of 20 l by this_aday of 20 N by
�Y�t�i�l b,O�e✓ ���/%n 5 �lt/ISD //r✓r S
Name of person making statement Name of person making statement
Personally Known �OR Produced Identification Personally Known AOR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Signature of ary it °" ate of F4dNtdi}OBERTs (Signature of ry Publi . f FloridSAYHY J ROBERTS
_ • L•�= Notary Public-State of Florida : • �•. Notary Public State of F]Assn.
� e`, Commiss' �G 316785 �' o' Co issi N GG 3167
o-:
Commission No. o Comm.EOr 'May 10,2023 Commission No. o: My C. ��res May 10
Bonded through National Notary Assn.
Bonded through National Notar
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17