HomeMy WebLinkAboutPermit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date
Permit Number:
•
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 APPLICATION FOR: Roof
PROPOSED IMPROVEMENT LOCATION:
Address: 103 Riverview DR Jensen Beach, FL 34957
Legal Description: TOP OF WALTON SID LOT 28 (OR 4048-2232)
Property Tax ID #: 4504-601-0028-000-6
Site Plan Name: Cory Dunn
Project Name: Cory Dunn
Setbacks Front
Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Remove existing roof and replace with new 5V Metal Roofing System
5V Metal(17022.1) TRI-BUILT Smooth(16048.1)
Lot N o.
Block No.
CONSTRUCTION INFORMATION:
Additional work toe K)ertormed under tis permit — check III app y:
❑ElHVAC Gas Tank ❑Gas Piping _ Shutters ❑ Windows/Doors
❑ Electric ❑ Plumbing ❑ Sprinklers ❑ Generator Roof 2�12 Roof pitch
Total Sq. Ft of Construction: -
Cost of Construction: $ 9,90C
1800
S Ft. of First Floor:
Utilities: LJSewer ❑Septic Building Height: 11Ft
OWNER/LESSEE:
CONTRACTOR:
Name Cory Dunn
Name: Dee Keihn
Address: 103 Riverview DR
Company: PDKRoofing.lnc
Address: 1299 SW Biltmore Street
City: Port Saint Lucie State: FL
Zip Code: 34983 Fax:
Phone No. (772)528-0113
City. Jensen Beach State: FL
Zip Code: 34957 Fax:
Phone No. (772)528-0113
E-Mail: PDKRoofing.lnc@gmail.com
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail: PDKRoofing.lnc@gmail.com
State or County License: CCC1331408
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:,
BONDING COMPANY:
Name:_
Address:
City:_
Zip:
Phone:
Not Applicable
State:
Not Applicable
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, wails, 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 jobsite
before the first inspection. I ou intend to obtain financing, c It with lender or a attorney before
com h in work ec in our Notice of Commenceme t.
Signs ure of Owner/ essee/Contractor as Agent for Owner
ig Contractor License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF !�i' Clti
COUNTY OF _ We�
The forgoing instru ent was acknowledged before me
The forgoing instru gent was acknowledged before me
thisKdayof_lVk L 20ZV by
this �� day of ti L 29aO by
Name of person making statement
Name of person making statement
Personally Known �'_ OR Produced Identification
Personally Known X OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
{Signature Notary Public- Sta a of F)rida)
{Signature &f Notary Publi - Sta of Flo ' a )
Commission No. (Seal)
Commission No. •• •.
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ALEMNIlERAGUIRRE
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REVIEWS
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PLANS
VEGETATION
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REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17