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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE-ACCEPTED "�
Date: Permit Number: C �
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 XX
PERMIT APPLICATION FOR: Roof
PROPOSED INf'PR®�/EMENT LOCA1'I®
Address: 445 CAMPBELL-ROAD, FORT PIERCE
Legal Description: 9 35 39 N 175 FT OF S 413.71 FT OF S 1/2 OF 3 1/2 OF NE 1/4'OF SW 1/4-LESS E 30 FT
Property Tax ID#: 2309-314-0001-00075 Lot No.
Site Plan Name: Block No.
Project Name: INGRAM/REROOF
Setbacks Front Back: Right Side: Left Side:
DETAdLEi ®N
TEAR OFF SHINGLE, RENAIL DECK. INSTALL NEW JA TAYLOR ROOFING EDGE-LOC 1"SS
METAL PANEL ROOF SYSTEM (NOA# 18-1023.17) OVER OWENS CORNING WEATHERLOCK
TILE & METAL SELF-ADHERED LINDERLAYMENT (FL#9777.7).
CONST IJCTION INF®RiVIATION:
Additional workto a er orme under t is permit—check a appy:
HVAC Gas Tank []Gas Piping _Shutters Q Windows/Doors
Electric 0 Plumbing Sprinklers Generator Roof 6/12 Roof pitch
Total Sq. Ft of Construction: 4,100 Sq. Ft.of First Floor: 3,423
Cost of Construction:$ 26,050 Utilities: Sewer Septic Building Height: 1 STORY
®WN'ER�/hE SEE: CONTRACT®R:
Name BONITA INGRAM Name: KYLE WHITE
Address: 445 CAMPBELL RD Company: J.A.TAYLOR ROOFING INC
City: FORT PIERCE State: FL Address: 302 MELTON DRIVE
Zip Code: 34945 Fax: City: FORT PIERCE State:FL
Phone No.772-461-4510 Zip Code:' 34982 Fax: 772-468-8397
E-Mail: CORBINSFARM@EARTHLINK.NET Phone No. 772-466-4040
Fill in fee simple Title Holder on next page(if different E-Mail: NADINE@JATAYLORROOFING.COM
from the Owner listed above) State or County License: CCC1325895
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
St!';PPLENfENTAL C I III! 1C`I 1®N LI!EN I�U1l IN ®Ri�I�Tf®Ne: low
DESIGNER/ENGINEER: of Applicable MORTGAGE COMPANY: of Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone ' Zip: Phone:
FEE SIMPLE TITLE HOLDER: r Ndt Applicable BONDING COMPANY: L,N.ot 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 pro erty.A Notice of Commencement must be recorded and posted on jobsite
before the first inspec ' . If you inte obtain financing, consult with lender or a ttorn fore
commencingwork recordingou N ice of Commencement:
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF STLUCIE COUNTY OF STLUCIE
The forgoing instrument was acknowledged efore me The forgoing instrument was acknowledged before me
this 10TH day of FEBRUARY 2 y this 10TH day of FEBRUARY 20QDy
KYLE WHITE KYLE WHITE
Name of person making statement Name of person making statement
Personally Known xx OR Produced Identification Personally Known xx OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Si ature of Notary Public-State of F�t�441 NADINEMA A ignature of Notary Public-Sta%4R ida l IIMP
?° Commission#GG 3 52 * Commission#GG 355203
Commission No. GG 355203N9093 GG 355203 tD9Aa�er �
ovember 15,2023
pXmmission No. OFfoa� Budget NotaryServees
BondedThruBudgetNotary 3elvices
ff OF f•�
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW _ REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17