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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Permit Number:C �� 0
Date:
RECEIVED
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Building Permit Application
Permitting Department
Planning and Development Services St. Lucie County
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:
PROPOSED IMPROVEMENT LOCATION:
Address: 6202 Alexandria cirj Ft Pierce,Fl 34982
Property Tax ID#: 3410-503-0283-000-9 Lot No.
Site Plan Name: Block No.
Project Name:
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DETAILED DESCRIPTION'OF.WORK'
Reroof shingles to shingles peel and stick undedayment
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 _Roof 5 Pitch
Total Sq. Ft of Construction: 3000 Sq. Ft.of First Floor:
Cost of Construction:$ 10500 Utilities: —Sewer —Septic Building Height:
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OWNER/LESSEE: CONTRACTOR:
Name Catherine Chagnon Name:roland Wiley
Address:6202Alexandria cir Company:shorelinerooflng
City: ft pierce State: Address:1973 sw Glendale st
Zip Code: 34982 1 Fax: City: Port st lucie State:fl
Phone No. Zip Code: 34987 Fax:
E-Mail: Phone N0772-260-9565
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 or more,a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CONSTRUCTION„LIEN LAIN INFORMATION - �`
DESIGNER/ENGINEER: _Not Applicable MORTGAGE'COMPANY: _Not Applicable
Name: Name:
Address: I 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 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.
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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 AN ATTORNEY BEFORE RECO RDI U OTICE OF COMMENCEMENT.”
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Signature of Owner Lessee/Contr c or as Agent for Owner Signature of Contractor/License Ho der
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF C JT �oA,��4 COUNTY OF �' C-1
The forgoing instrument was acknowledged before me The for oing instrument was acknowledged before me
this6�6 ii day of � [?A— 20_j_�by this day of��� 20� by
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Name of person making statement. Name oV person making statemen .
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identificatir Type of Identification
L
Produced L Produced
(Signature of Notary Public-St re of Notary Public-SZT
" ELLEN VAUG
y ELLEN VAUGSte of Florida Nota PUbIiC Commission No. a omrnlnsibn # GG 7§9®►7P sion No. of Florida-Notar blicMy Colflffilbolon F pires ommission #GG 2 79October 22, 2n 2M Commission 6)October 22Y0.2i sREVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Kev. 2/7/19
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