HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFOMUSTBE COMPLETED FOR APPLICATION TO BE ACCEPTED �l I n
Date: 1 U' 3y"I I Permit Number: A l t® - o � D�p oi
i
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential X
PERMIT TYPE: �oo� S�qkvi
PROPOSED IMPROVEMENT•LOCATION
Address: 5771 Travelers way Ft Pierce,F134982
Property Tax ID #: 3410-503-0094-000-7
Site Plan Name:
Project Name: _
-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:
Lot No.
Block No.
Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof 5 Pitch
Total Sq. Ft of Construction: 3000
Cost of Construction: $ 10500
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
NameAnne Persandi
Name:roland wiley
Address:5770 Travelers Way
Company: shorelineroofing
Address:1973 sw Glendale st
city: ft pierce State: 1'I
Zip Code: 34982 Fax:
City: port st lucie State:fl
Phone No. —,--Zip
Code: 34987 Fax:
E-Mail:
Phone No772-260-9565
E-Mail shorelineroofing@yahoo.com
Fill in fee simple Title Holder on next page ( if different
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 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORIVIATIQN
,
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 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
E ER OR AN RNEY BEFORE RECO ING-XJWR MKICE OF COMMENCEIRNT.WAS
1
Signature of Owner/ Lessee/Contra or a Agent for Owner
Signature of Contra ctor/Liceynlse_Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF 511,.14
COUNTY OF
The forgoing instrument was acknowledged before me
The r oing instrument was acknowledged before me
this day of 20_ by
`
this day of _ e 20 by
�1� �1_�
Name of person making statemen
Name of person making statemen
Personally Known OR Produced Identification
Personally Known OR Produced Identificatio��
Type of Identification
Type of Identification
Produced
Produced
DA A(k " hm YD
i a ure of Notary Public-S ate of Florida j
ig .rgaf;i9L _ ._ I n a
No.
LASHAHNA INGRAM-RAHMINC
SI)Commission
Commiss(o
nGG
�r
"°ah9YCO
:
27506LASHAHNAINGRAM-RAHMING XPIRES: Decembar20, 2022
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__ My COMMISSION # GG 275060
.. 130a o
EXPIRES: Dece
ber20, 2022
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DATE
RECEIVED
DATE
COMPLETED
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