HomeMy WebLinkAboutPermit AppAll APPLICABLE INF1 MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
Building Permit Application
Planning and Develo ment Services
Building and Code B gulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial
PERMIT TYPE:
Y p,�'
Address:
OVEMENT LOCATION:
&tbimc 3)yu
Property Tax ID #:
Site Plan Name:
Project Name:
�,•�
aci K.
r R
State: �G
Fax:
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DETAILED DESCRIPTION
OF WORK:
Re -Roof
Title Holder on next page ( if different
listed above)
Additional work to
_Mechanical
Electric
Total Sq. Ft of Con:
Cost of Constructic
119[i1PE
Residential X
Lot No. 2—
Block
Block No. I _
performed under this permit — check all that apply:
_ Gas Tank _ Gas Piping _ Shutters ww_ Windows/Doors
_ Plumbing _ Sprinklers _ Generator C>40of *2- Pitch
action: 0 Sq. Ft. of First Floor:
krPA
$ 945(v C) Utilities: (Sewer _Septic Building Height: 20
OWNER/.ESS
:
CONTRACTOR:
Name
Address: Orf
City:
Zip Code:
Phone No.()
_LjE-Mail:
Fill in fee simple
from the Owner
1/ n
Name: Robert Donovan
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Company: Total Home Roofing
State: �G
Fax:
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Address: 597 Haverty Court, Suite 40
City: Rockledge State: F
Zip Code: 32955 Fax:
Phone No 321-452-9223
Title Holder on next page ( if different
listed above)
E -Mail Christa@throof ing.Com
State or County License CCC1330489
If value of construction is.>zeuu or more, a ncwnwcv ,.,..,,.� �• ••--•••- - if value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL
CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGI
Name:
Address:
City:
Zip:
EER:
_ Not Applicable
MORTGAGE COMPANY:
Name:
Not Applicable
Address:
State:
Phone
City:
Zip: Phone:
State:
FEE SIMPLE TITL
Name:
Address:
City:
Zip:
HOLDER:
Not Applicable
BONDING COMPANY:
Name:
Not Applicable
Address:
City:
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 the permit holder to build the subject structure
which is in conflict wi Lh any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please con wit with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration oft the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
in accordance with tir e approved plans, the Florida Building Codes and St. Lucie County Amendments.
The following buildin 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 O NEW YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING
TWICE FOR I PROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON T E JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR L NDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signature of essee/Contractor as Agent for Owner Signature of r r/License Holder
STATE O FL R DP STATE OF L �DA p _ a�
COUNTY OF n 1 COUNTY OF IM &
The for,gg�oing instr ment was acknowledged before me The fo�r,ggoing instryment was acknowledged before me
this L day of 20 IV by this; day of 20 A by
Robert Donovan
Name of person m king statement. Name of person making statement.
Personally Know R Produced Identification Personally Known Z/-- OR Produced Identification
Type of Identification Type of Identification
of Florida 1 (Sign ure of Notary Public- S
Commission No. ...t-LYNSALMO Wm ssionNo.t.rP9 uuo IdOMMISSION#GC
:,_ MY COMMISSION # GG 883 EXPIRES: March 10,
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