HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
s
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 S/D 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:
DETAILED DESCRIPTION OF WORK:
Right Side: Left Side:
Lot No.
Block No.
Replace flat roof Polyglass SBS and APP Modified Bitumen Roof Systems (FL1654-R23)
CONSTRUCTION INFORMATION: _ I
itiona I work to be erformed undert this permit —check a appy:
HVAC Gas Tank 0Gas Piping Shutters Windows/Doors
Electric Plumbing E Sprinklers a Generator Roof 1 512 Roof pitch
Total Sq. Ft of Construction: 4sgs
Cost of Construction: $ 3.000.00
S q. L. of First Floor: _
Utilities: Sewer 11 Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Gory Dunn
Name: Dee Keihn
Address: 103 Riverview DR
Company: PDKRoofing.lnc
Address: 1299 SW Biltmore Street
City: Jensen Beach State: FL
Zip Code: 34957 Fax:
Phone No. (772)528-0113
City: Port Saint Lucie State: FL
Zip Code: 34983 Fax:
Phone No. (772)528-0113
E -Mail: PDKRoofing.lnc@gmail.com
E -Mail: PDKRoofing.inc@gmail.com
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
State or County License: CCC1331408
it value of construction is �AZ500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
Name:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
Zip: Phone:
Address:
City:
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 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 posted on the jobsite
befor he first inspection. .If� you int d to obtain financing, c�I cult with lend or an at�rn b re
com ler ing work prlreco�cllnjz vo�e of Commencemefrt N � / �e
Signature of Owner Lessee/Contractor as Agent for Owner I Signature of Contractoy'/Li6ense Holder
STATE OF FLORIDA STATE OF FLORrDA
COUNTY OF -c__ COUNTY OF '� .
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this I (.o daffy of Ao r 1 20 1V by this 14 day of t 20_2z!�, by
�-c 2 F,
Name of person making statement Name of person making statement
Personally Known yC OR Produced Identification Personally Known K OR Produced Identification
Type of Identification Type of identification
Produced Produced
(Signature of otary Public- State ofrida } (Signatu of Notary Public- Sta of ida }
Commission No. D RAGUIRRE Commission No. ALEXANl7 AG
hcKst ALIJ �_
�: ,i MY COMMISSION # GG 234811 = ; ,• *s MY COMMISS14N # GAG 234811
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REVIEWS F PLANS VEGE E
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17