HomeMy WebLinkAboutAlbertson ResidenceAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
i2 41�1 � Al iim lil� X'n Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Address: 10951 Wetland WAYJensen Beach, FL 34957
Property Tax I D #: 4509-802-0001-000-3
Site Plan Name:
Project Name: Albertson Residence
Tear off existing roof, Inspect and renail wood , Install 30# Underlayment and Metal Panels
New Electrical Meter Second Electrical Meter
Additional work to be performed under this permit— check all that apply:
_Mechanical _ Gas Tank —Gas Piping _ Shutters
_Electric _Plumbing _Sprinklers
Total Sq. Ft of Construction: 4000
Cost of Construction: $ 30,700.00
_ Generator
Sq. Ft. of First Floor:
Lot No.
Block No.
_ Windows/Doors _ Pond
Roof Pitch
Utilities: _Sewer _Septic Building Height: IIfJ'
Name h ttr l! >A PI e
Address:109 Weand 1 tlWAY f
City: Jensen Beach, State: _
Zip Code: 34957 Fax:SAME
Phone No. SAME
E-Mail:SAME
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Na
City: Stuart State: FL
Zip Code: 34997 Fax: 772-872-8033
Phone N0772-872-8030
E-Mail Samira@totalroofingsystems.net
State or County LicenseCCC1330788
f value of construction is 2500 or more. a RFrnRnFn Nntire of rnmmenremant is rnm Jrcd
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
Name:
Address. -
City; State:
Zip: Phone
zip;
Address:
City. State:
Zip; Phone
permit to do the work and Installation as indicated.
The following building permitapplicatiomore 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
lgna re of Own es` ntractor as Agent for Cawner
Signature of CoritractorlUcense Holdef
STATE OF FILORIDA
STATE OF F1.t1RIDA
COUNTY OF lei a r+i /1
COUNTY OFA - - -i n r
77Sworr" {or affirmed) and subscribed before me of
gtj
Svrpy t,61i r affirmed) and subscri ad beforeme of
hysicatPresenceor_,online Notarization
Physical Presence or— nUno,Notattzation
this ^ day of20202020 by
this _ day c 2020 by
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Name of person making statement- s'
Name of person making statement.:
Personally Known 't-'� OR Produced fdentificaXion;�,,,_,,,
Personally Known. r`„f OR Produced Identification.
Type of identification
Type of Identification
Produced-.,--- -" /
Produced - - --�
lotpry Public- State of Florida)
Whatu of`kotary Pu4IlcrState of Florida )
CommissionNm 4�cr 1q -73 (Seal)
Commission No. (rCi- 1 11 I tip (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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