HomeMy WebLinkAboutIlsley Permit AppAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
f Date: Permit Number:
91F. -
BU;Iding Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virgini*venue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:Reroof: Shingles
PROPOSED IMPROVEMfiNT LOCATION:
Address: 8189 Buckthorn Cir
Property Tax ID #: 342570100990006 Lot No.6
Site Plan Name: lisley Residence 4 Block No. 4`
Project Name: lisley Residence
LP E TAILED.DESCRIPTION:OF WORK:
Tear off existing shingles down to wood deck. Inspect/Repair/Renaii wood deck. Install GAF Weathecwatch self
adhered undedayment. Install GAF HDZ shingles. Flat roof to receive Polyglass SAP
New Electrical Meter Second Electrical Meter
CON STRUalON 1NFORM'ATION:
Additional work to be performed under this permit —check all that apply:
_Mechanical — Gas Tank —Gas Piping _ Shutters -Windows/Doors _ Pond
_ Electric _ Plumbing Sprinklers _ Generator LM Roof 3/12 Pitch
Total Sq. Ft of Construction: 1600 Sq. Ft. of First Floor:
Cost of Construction: $ 8000 Utilities: —Sewer _Septic Building Height: 10
OWNER/LESSEE: CONTRACTOR:
NameRobert lisley Name:Andrew Keys
Address•2302 Woodview Dr Company:Andrew Thomas Contracting LLC
City: Alpena, MI State: _ ' Address: 1193 SE Port St Lucie Blvd #322
Zip Code: 49707 Fax:` City: Port St Lucie State: Fl
Phone No.9856576806 Zip Code: 34952 Fax:
E-Mail:bilsley@silcpa.com Phone No7726261250
Fill in fee simple Title Holder on next page (if different E-Mail andrewthomascontracting@gmail.com
from the Owner listed above) State or County License CCC 133 1638
If value of construction Is 2500 or more, a RE oRDED Notice of Commencement Is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
City: _ State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: 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
is in
which 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 paying twice for
improvements to your property. A Notice of Commencement must be recorded in the public records of St.
Lucie County and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
with lender or an attorney before commencing work or recording our Notice of Commencement.
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Signature of Co tractor/ icense Holar
Signature of Owner/ Lessee/Contractor as Age t for Owner
MiCh)C.AIV.
STATE OF F.�kBA
COUNTY OF A,- Lie K) 14-
STATE OF FLO
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Sworn to (or affirmed) and subscribed before me of
Sw.or b (or affirmed) and subscribed before me of
Physics! Presence or Online Notarization
v P ysical Presernc or Online Notarization
this (jday of �2020 by
this day of , 2020 by
Name of person making statement.
Name of person making statement.