HomeMy WebLinkAboutRoof inspection affidavitALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
w
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34082
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential x
PERMIT APPLICATION FOR: Roof
PROPOSED IMPROVEMENT LOCATION:
Address: 7212 Mystic Way Port St Lucie, FL 34986
Legal Description: MYSTIC PINES AT THE RESERVE LOT 4 (OR 1074-117 AND 119)
Property Tax ID #: 3322-620-0009-000-5
Site Plan Name: Gus Dimino
Project Name: Gus Dimino
Setbacks Front Back:
I DETAILED DESCRIPTION OF WORK:
Right Side: Left Side:
Remove existing roof and replace with new Tile Roof System
Estate S Tile(28328.3), 30#(12328.7), Tu Plus(5259.1), Off Ridge Vent(16994.2),
ICP Adhesives Polyset(6332.1)
Lot No.
Block No.
CONSTRUCTION INFORMATION:
Additional work to be j rformed under tis permit —check all that apply:
HVAC L_J Gas Tank EGas Piping _ Shutters Windows/Doors
11 Electric ❑ Plumbing Sprinklers ❑ Generator W1 Roof 6112 Roof pitch
Total Sq. Ft of Construction: 3800
Cost of Construction: $ 35,600
SFt. of First Floor:
Utilities:nSewer Septic Building Height: 1 Story
OWNERAESSEE:
CONTRACTOR:
Name Gus Dimino
Name: Dee Keihn
Address: 7212 Mystic Way
City: Port St Lucie State: FL
Zip Code. 34986 Fax:
Phone No. (772)528-0113
Company: PDKRoofing.lnc
Address: 1299 SW Biltmore Street
City: Port Saint Lucie State: FL
Zip Code: 34983 Fax:
Phone No. (772)528-0113
E -Mail: PDKRoofing.lnc@gmail.com
Fill in fee simple Title Holder on next page i if different
from the Owner listed above)
E -Mail PDKRoofing.lnc@gmaii.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:
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:
Address:
City:
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
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"e first inspectio If "intend to obtain financing, ��ccaa�nnsult with lender or an attorne before
coml�itri _work or r co nR vow" Notice of Commencement.
Signature of Owner/�4sse'e/Contractor al -gent for Owner I Si�,l�ure of
Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF r - ILLI a COUNTY OF c --)V . LA—Lu e,
The forgoing instrument was acknowledged before me The forgoing instrunt was acknowledged before me
this I t- day of 2010 by this 1'L day of MT , 20 ID by
DC' e— DR 42- VS e-t"iia n
Name of person making statement Name of person making statement
Personally Known J C` OR Produced Identification Personally Known 0;, OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(* �
LS--= L
4ce_�
(Signaturitof Notary Public at
of Florida j
(Signature otary
Commission No.
r
EX
AL]
iA4UIRRE
'11°1 ALEXANDER AGUIRRE
Commission No. ` YCOMFAIGG234811
is
MY COMMISSION # GG 234811
EXPIRES: July 4,2022
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os
EXPIRES: July 4, 2022
F ;°$ Bonded Thry Nolary Public Und mThers
, moo.
REVIEWS
FRONT
ZONING SUPERVISOR
PLANS VEGETATION SEATURTLE MANGROVE
COUNTER
REVIEW REVIEW
REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. $/2/17