HomeMy WebLinkAboutGwens Reroof Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 14/ i oza Permit Number:
Application
Building Permit
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 .
PERMIT TYPE:
PROPOSED IMPROVEMENT LOCATION:
Address:
Property Tax ID#: ��i �, _ a� C3C� ZZ ���� _ Lot No.
Site Plan Name: Block No.
Project Name:�'� <s
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�C T
_ON'I'N'FORMATION,�
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 Z ✓z. Pitch
Total Sq. Ft of Construction: �r �L 09 Sq. Ft. of First Floor:
Cost of Construction: $ 0 00 Utilities: —Sewer —Septic Building Height: t Z
Name l �^'�(y , i°Lc'� 1i Name: r • r e �,� �,os
Address: Company: �.S c c S'"'n
City: State: _E�f Address: AA
Zip Code: 3L�°1 g `Z Fax: City: Pcr�— S-+- L ' Li e- State: �L-
Phone No. Zip Code: 43tfiq S Fax:
E -Mail: Phone No 0-11) –
Fill in fee simple Title Holder on next page ( if different E -Mail a,--I-,j�at e_1 nGS o Lj Q a o � , C
from the Owner listed above) State or County License C C_ r1 3 i
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER:
_ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name:
Signature of Contractor/License Holder
Name:
Address:
COUNTY OF,
Address:
City:
State:
City: State:
Zip: Phone
141
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Zip: Phone:
Name of person mak statement.
FEE SIMPLE TITLE HOLDER:
_ Not ApplicableBONDING
COMPANY: Not Applicable
Name:
Type of Identification
Name:
Address-.__
ddress:
.r_. _.. c� My Commissio$��o� Expires 02/1172
Address:
City:
(Signature of Notary Public- State of Florida )
City:
Zip: Phone:
Commission No.?, (Seal)
Zip: Phone:
REVIEWS
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do tine work and instauation as inoicaLeu.
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 JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Rev.2/7/19
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF,
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this day , 21)a by
this day of 20 by
141
arl-u "d;:1 ��eYlf a`YJ
Name of person mak statement.
Name of person making statement.
Personally Known d I ifi
Known OR Produced Identification
T e of Identification ,
YP v� Notary Public Sproduced
Type of Identification
niPersonally
�.►`
Produced L F M GiosiM,
.r_. _.. c� My Commissio$��o� Expires 02/1172
( nature of Notary Public- State of Florida)
(Signature of Notary Public- State of Florida )
Commission No.?, (Seal)
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.2/7/19