HomeMy WebLinkAboutHawthorne ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 8/21/19
Permit Number:
M702=1
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
Address: m Q C-ACks.
Legal Description: uwL %--t u-'�- X-L,-N --,3
��ACte' 11
X-�. UkOn LI)VAXU
Property Tax ID #: em -ocok'o Lot No. Vzz
Site Plan Name:
Project Name: Lvr g\_
Setbacks Front Back:
Right Side:
Remove tar & gravel roof and replace with
Left Side:
Qc�
Block No.
Additional work to be nertormed under this permit - cneck all t1lal, apply:
F1HVAC n Gas Tank F]Gas Piping F]Shutters F]Windows/Doors
nElectric F-1 Plumbing OSprinklers FiGenerator Z Roof Roof pitch
Total Sq. Ft of Construction: 12±89 Sq. Ft. of First Floor:
Cost of Construction: $ PC) Utilities: n SewerF I Septic Building Height:
Name
Name: Jamie Cisco
Address: 'k Or" Ckc, t rl. S
Company: Sunshine Roofing, LLC
City: 'r'� V_-_kc4 r'_V) State: FL
Address: PO Box 1083
Zip Code: Fax:
City: Palm City State: FL
Phone
Zip Code: 34991 Fax:
E - M a i 1U. L,-,AAI M k-u, L\
Phone No. 772-260-8195
E-Mail: sunshineroofingllc@gmaii.com
Fill in fee simple Title Holder on next page (if different
State or County License: CCC1 327796
from the Owner listed above)
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone
MORTGAGE COMPANY: _ Not Applicable
Name: Jamie Cisco
Address:
City: Palm City State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: PO Box 1083 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
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
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.
Signature ner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLO I9A
COUNTY OF ,� 4�
COUNTY OF , r` (+ t -N
The for ing instru ent as acknowled efore me
The for oing instrurrf nt was acknowled d before me
this day of, - 20" y
this °¢ay of s~ "` _, 20 by
�' I � pc
t t) , , '-L—L� 0 ,
4
Name of p 00 making statement
Name of person ing statement
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Pro uce
(Signature
f
(Signature of Notary Public- lorida )
Commissi
Jo KRISTIE DYE
"= 00
Commission _KRISTIED Seal
4< EXPIRES: tuber 11, 23
COMIC MION # GG 939200
3111,
Pub1 UrKierurit
SWedThru ers
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EXPIRES; Decemlaer 19,
—2023
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REVIEWS
FRONT
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SUPERVISOR
PLANS
MANGROVE
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REVIEW
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REVIEW
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DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17