HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: J111L[ y
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Building Permit App licatiOtWEB 1 ® 2020
Planning and Developme nt Services
Building and Code Regulation Division Permitting Department
2300 Virginia Avenue,Fort Pierce FL 34982 fit. LU�j County, FL
Phone: (772)462-1553 Fax: (772)462-1578 Commercial
-",PERMIT TYPE:reroof
PROPOSED IMPROVEMENT LOCATION':'
Address: 5942 travelers way
Property Tax ID#: 3410-503-0111-000-3 Lot No.1
Site Plan Name: Block No. C
Project Name:
DETAILED DESCRIPTION OF WORK:
reroof shingle to shingles peel and stick underlayment
5112 pitch 0 /067 q F157
fl 16048-r6 3000 SF
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:
OWNERAESSEE: CONTRACTOR:
NameAgostinelli Assunto Name:roland wiley
Address:5942 travelers way Company:shoreline roofing
City: ft pierce State:_ Address:1973 sw,Glendale st
Zip Code: 34952 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 License CCC1331170
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 INFORMATION
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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: 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.
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
POST THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITFf YOU OR AN ATTORNEY BEFORE RECO RDI Y OTICE OF COMMENCEMENT."
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Signature of Owner/Lessee/Contra ent for Owner Signature of Contractor/Licens Holder
STATE OF FLORIDAA �&� STATE OF FLORID
COUNTY OF COUNTYOF
The forgoing instr ent was acknowledged before me The forgoing instr ent was acknowledged before me
this day of 2C by this LID day of 2 : b by
�i I la43 5,4
Name of person making statemen U
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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(Signature of Not Public-State of Florid (Si nature of tary ublic-State of Flo ida )
Commission No. :`i�. DAB, �, C +4�7 ic�fir�l ,UAUDRESeal
MY COMMISSION GG 300817 = ` ��`.• SIRES:March 8-2023
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