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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO B E ACCE PTE D
Date: 08/11/2020
Permit Number:
.r
Building Permit A plication
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 111
ir
PROPOSED IMPROVEMENT LOCATION:V--'- 6r
r- r
•'� �r �� jr s r ��� �
Address: 8601 SANTA CLARA BLVD., FART PIERCE F-L
legal Description: LAKEWOOD PARK -UNIT 8-8- BLK 3 LOT 2 {MAP 13/02N) (OR 3836-2705)
Property Tax ID #: 130i-61Q-0�3fl-ODO-9 Lot No.2
Site Plan Name: N/A Block No 3
Project Name: NIA
Setbacks Front N/A Back: NA!Right Side: NSA Left Side: NIA
DETAILEDDESCRIPTiON DF VIWORK.
partial re -roof: we w'IF11 tear off the ed is
Current code,. ins#a4f a self- a d hR__c,%'1VPh
0
ting roofing on the rear fiat roof. we will nail the jacking o ff t10
o-011 ie
.. �itumen ease Icap. install the eaV�s meta! nailed U LU cede and
primed with a pri er. install aself-adhesive bitumen cap sheet with a white granular su rface
HVAC
Electric
7 Gas Tank
J Plumbing
Total Sq. Ft of Co n st ru cti o n; 6500/ 6 1/2 Sq
Cast of Co nstruction: $ �4��•QQ
OWNER/LESSEE
]Gas Piping
Sprinkle
rr�•
_ Sh utte rs
Generator
Windows/Doors
Roof F
5 Ft. of First Floor; N/A
Utilitleso.l5ewer 1 Septic Building Height: NIA
Name Us Bank Trust N A (TR)
Address.3630:Peachtree Rd NE Ste 1500
titY: Atlanta State: GAmmmpqm�
I -M
Zip Code.. 30326 Fa x: NIA
- -
Phone Na. NSA
E-Ma'PtI: NIA
F�li in fee simple Ti tfe Holder on next page [ if different
from the Ownerlisted above)
CONTRACTOR..a
Name: Christop h er Co 11 ins
Company: Collins Roofing Inc.
Addre
Ss: P+0- fax 12867
City; tot, pierce State
dip Code
Roof pitch
• L
• 3`'yry Fix: 772-489-6505
Phone No. (t4r-/-U1-1352
E-Mail: C01linsroa�inginc cQgma
State or County License: CCC-0580.11,
If value of constriiction Is $2500 or more, a RiECORDED Notice of Commencement is required.
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SUPPLEMENTALCONSTRUCT�ON LIEN LAW INFORMATION.
"'V
DESIGNER/ENGINEER: Not Applicable
N a m e : US Bank Trust NA CrR)
Ad d ress: 0601 SANTA CLARA BLVD., FART PIERCE FL
Clty: Atlanta State:
Zipm Phony
FED SIMPLE TITLE HOLDER: Nat Applicable
mame.
Addre ss: P o� Box 12s67
C 11, t y
ZIP:. Phone•
OWNt:Rj CQNTftACTpR AFFIUVIZ'• Application is hereby made to obtain a permit to da the work and installation as indicated.
MORTGAGE COMPANY0
:
Not Appl'Icable
Name:
A d d re S 5 -OP 34M Peachtree Rd N E She 1500
City' FL Pierce0 State:
dip: Phone.
BONDING COMPANY: , Not Applica ble
rvam(:
Address:
City;
zip: Phone'
��I if ILr»L nu vwOfK or Installation has commenced prior to the issuimce Of a permit.
St. Lude C-no rtity r'r'ralrac :11 - --• -
whi�F► is in conflict witF� anY applicable�Home Oywgranungers s
ulesauthori2e
a r and covenholder
at build
the
ct ojeptstructure
Fiibuh
structure. Please consult with your H o m e owners Association and review your deed far any restrictions which may apply.
I n consideration of the granting of this requested permit,, I do hereby agree that I will, in al! respects, perform the work
in accordance with the approved plans, the Florida Building Cvdes and St. Lucie Cou Amendments.
The followiln$ � _Iding permit a,�l1ations are exempt foram undergoing a ful oncurrenc re��ro�m additfanIS,
nrroe�w.
�LIu«ur s,swi g poo fences, walls, signs, screen room
W NING Tp ER: Your I re to Retard a Notice of Co-r.-. T
eTflre LTl
ommev�i
w
s d accesso s s to:anot non-residential use
manta 1W15L ma resu{t I n vo ioaviniz twice for
w�yF,�nr�H i1duuce OT Uommencer�rent mi,s
intend to finanobtain ng, con
our. Notice of Comm cement
fec rd e d posed on the jobsite
ith or an attorney before
SIk - essee/Contractor as Agent for Owner lgfg
STATE OF FLORIDA� STATE OF FLO A
COUNTY OF �r t119((f�-COUNTY OF 'r
The forgaing instrument was acknowledgedfore me
this Tf day of 20!9iy
/A /I r n f t 1�
person making statementir
Name ak L LL
Personally Known OR Produced Identification
Type of Identification
Produced ef�41�
(Signature of Notary Public - State of nrid y
Co m m Issi u n N o.- 1� in
REVIEWS
DATA
RECEIVED
DATE
COMPLETED
Rev. 8/2/17
1 J
FRONT
COUNTER
ZONING
REVIEW
The for
this I
0
s instru ant was arknowfedgecbefore me
Y of Y., ) S-1
icense Bolder
r
2 b y
-
Name of 0 er5on fl'1akIf1Perscynally K own � �a te m ef1t
OR P Od Ced Identification J
Type of Identification
Produced E71 ;01
�5ignature of Notary Pub' sc- state of
RebekahHpy
NOTARY PUSL
STATE OF FL �Mission No. F_
-0114
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SUPERVIS0 R
REViEW
PLANS
REVIEW
VEGETATION
REVIEW
SEA TURTLE
RE dIEW
F* NOTARY P
R ~STATE 01=
• C O GG
N GRQVE
REVIEW
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