HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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- - - Building Permit Application
Planning and Development Services
Building and Code Regulation Division
12300 Virginia Avenue, Fort Pierce FL 34982
,Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential X
:PERMIT TYPE:reroof
1PROPOSED`IMPROVEMENT LOCATION;
Address: 5925 travelers way
3410-503-0069-000-3 1
Property Tax ID #: Lot No.
Site Plan Name: Block No. C
Project Name:
DETAILM DESCRIPTION OF WORK: -
reroof shingle to shingles peel and stick underlayment
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fl 18355-r4 .. 5112 pitch
fl 16048-r6 3000 SF
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[CONSTRUCTION INFORMATION:
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Additional work to be performed under this permit —check all that apply:
_Mechanica! _Gas Tank _Gas Pirninb _Shutters _ Windows; Doors
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_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof 5 Pitch
Total Sq. Ft of Construction: 3000 Sq. Ft. of First Floor:
Costof _nstructinn•..fi, 10500 11tiIIties: _Sewer Septic Buil inoa ioah •
OWNER/LESSEE;
CONTRACTOR:
Namedennis hoffman
Name:roland wiley
Company- shoreline roofing
Address:5925 travelers way
Address:1973 sw Glendale-st
IICity:
ft Pierce State: _
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Zip Code: 34952 Fax:
City: Port st lucie State:fl
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
State or County License CCC1331170
from the Owner listed above)
1 If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
If-.-I--e of u VAC IS 47,5^0 a, mare, -- 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: State:
;Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
(Address:
Name:
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.
Icertify 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 anplirationc are exempt from undergoing a frill conriurrency 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
WI NDER OR A ATTORNEY BEFORE RECORDING YOU OTICE OF OM ENCEMENT."
Signature of Owner/ Lessee/ ontract r as Agent for Owner
Signature of Contractor/License old
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF
The forgoing instr ment was acknowledged before me
The oing ins ment was acknowledged before me
this Ls_ day of 2&W by
this day of 20� by
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Name of person making statemen .
Name of person making statement.
Personally Known OR Produced Identification'
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
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