HomeMy WebLinkAboutPermit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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Building Permit Application
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
PROPOSED IMPROVEMENT LOCATION:
Address: 6304 E Seminole Rd Fort Pierce Florida 34951
Legal Description: Lakewood Park -Unit 6-BLK 65 LCT6 (MAP 131025)
Property Tax ID #: 130160601500003
Site Plan Name: Judy Jones
Project Name: Judy Jones
Setbacks Front Back
DETAILED DESCRIPTION OF WORK:
Owens Corning (FL10674-R15)
Tri built Sand (FL16048-R6)
Omniroll Ridge Vent (FL2847-R12)
Right Side: Left Side:
Lot No.
Block No.
Aaaamonai worK to oe errormea unaer tnis permit— cnecK all apply:
j�l�1HVAC _ Gas Tank E]Gas Piping _ Shutters Windows/Doors
J
LElectric ❑ Plumbing Sprinklers FIGenerator I Roof 511 Roof pitch
Total Sq. Ft of Construction: 2300 SFt. of First Floor:
Cost of Construction: $ 11250 Utilities: SewerSeptic Building Height: 1 Story
OWNER/LESSEE:
CONTRACTOR:
NameJudy Jones
Name: Dee Kelhn
Address:6304 E Seminole Rd
Company: PDKRoofing.lnc
City: Fort Pierce State: FL _
Zip Code: 34951 Fax:
Phone No. (772)528-0113
Address: 1299 SW Biltmore
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 ( if different
from the Owner listed above)
E -Mail: PDKRoofing.lnc@gmail.com
State or County License: CCC1331408
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: I
DESIGNER/ENGINEER: — Not Applicable
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:.
BONDING COMPANY:
Name:
Address:
City.
Zip: Phone:
Not Applicable
ate:
_Not Applicable
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
5t, Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
in accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
WARNING TO OWNER, Your failure to Record a Notice of Commencement may result in your paying twice for
improvements to your property. A Notice of Commencement must be recorded and posted on the jobsite
befor .the first inspect ita If intend to obtain financing,.ponsult with lender or an �$torne before
cum glnci work or recr�ng youl Notice of CommenceIF I�T' —
Signature of Owner/ LessLde/Contractor agent for Owner
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
this (0 day of v\5 20 0 by
_fie e_ tl,=•
Name of person making statement
Personally Known __ X OR Produced Identification
Type of Identification
Produced
(Signatu of Notary Public- at of Florida )
Commission No. XfX606RACIUME
MY GOMMISMA N GG 234$11
EXPIRES: July 4, 2022
REVIEWS ( FRONT ! ZONING
COUNTER I REVIEW
DATE
RECEIVED
COMPLETED
Rev. 8/2/17
of Contracto(ILrfense Holder
STATE OF FLORIDA
COUNTY OF S i L kL-L c
The forgoing instrument was acknowledged before me
this _(d_._ day of q tA-S �, 20 LU by
— - ire L'_ 1� e- I, \ -\ --
Name of person making statement
Personally Known 2,%, OR OR Produced Identification
Type of Identification
Produced
(Signature Nota
<i{ft!yy ALEXANDER AGUIRRE
Commission No. YCOIr1MIGE3234611
EXPIRES; July 4, 2472
d: swmw Tnru Notary Public Undwe tm
SUREVIIEWORI PLANS REVIEW I V EVIEWON SE EV EWLE J MREVEWVE