HomeMy WebLinkAboutBuilding permit applicationill APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: "
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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
PERMITTYPE:
PROPOSED IMPROVEMENT LOCATION:
Address: 107 S 36th ST Fort Pierce, FL 34947
Property Tax ID #: 2408-321-0001-000-1
Site Plan Name:
Project Name: _
-aA-L--
Lot No.
Block No.
I DETAILED DESCRIPTION OF WORK: I
Shingle re -roof
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit— check all that apply:
_Mechanical _ Gas Tank —Gas Piping _ Shutters
_ Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction: 1,370
Cost of Construction: $ 13,367.59
Sq. Ft. of First Floor:
Utilities: —Sewer _Septic
Windows/Doors
Roof Pitch
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Edward E Fuller
Name: Doug Leman
Company: Orchid Island Roofing
Address: 107 S 36th ST
City: Fort Pierce State: _
Zip Code: 34947 ;Fax:
Phone No. 772-302-1590
Address: 856 US Highway 1
City: Vero Beach State: FL
Zip Code: 32960 Fax: 772-999-2101
Phone No 772-643-5950
E-Mail
E-Mail: eddiefuller1956@gmail.com
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
State or County License CCC1329687
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
i
= 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
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 JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TOO TAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING Y94R.NOTICE OF CO ENCEMENT:-
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/Licen Holder
STATE OF FLO A
STATE OF FLORI
COUNTY OF % ( � \ W 0
COUNTYOF pi
The �i:gping instr en�was acknowledged before me
thi ( day of 2%�o by
Th orgoing ins ument was acknowledged before me
thiCLI day of 201&y
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Name of person making statement.
Name of person ma ,pg statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identific tion
Type of Identification
Produced
Produced
PON-A k.A_ A N
i&,)
(Signature Notary Pu. ' - of Florida
(Signature of Notary Public- State of Florida )
10 CARA
J�% MY CC5910ELLS
Commission No. ,LL
NkEE WOG058 546
., �XptREe Dec®mb®r 20, 2020
Commission No. ;;�''#'�`4k;; C�EE WELLS
My COMMISSION # GG056546
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DATE
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COMPLETED
Rev. 2/7/19