HomeMy WebLinkAboutPERMIT = POLKAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Sep/412020
Permit Number:
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential X
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FORA New Shingle & Flat Re -Roof
Ell, MENEM=
Address. 5706 E SEMINOLE RD
Property Tax ID #: 1301-604-0124-290-5
Site Plan Name:
Project Name:
Lot No.
Block No.
Remove existing shingles and flat roof system and replace with new Owens Corning Duration Shingles Over Peel & Stick Underlayment
With all new metal flashing,dripedge and plumbing vents, flat roof to receive one ply base self -adhered and one ply
- white self -adhered mod cap sheet and primed drip edge & transition flashing.
New Electrical Meter Second Electrical Meter
Additional work to be performed under this permit– check all that apply:
_Mechanical _ Gas Tank —Gas Piping _ Shutters _ Windows/Doors
_ Electric _ Plumbing
Total Sq. Ft of Construction: 2,400 SF
Cost of Construction: $ 1 O
_ Sprinklers _ Generator Roof 4 in 12
Sq. Ft. of First Floor:
— Pond
Utilities: —Sewer —Septic Building Height:
NameJohn F Polk Jr
Address:908 Lapidum Rd
City: Havre De Grace, MD State: _
Zip Code: 21078 Fax:
Phone No.
E -Mail, -
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: Rene Reyes
Pitch
Company: My Florida Roofinng Contractor
Address: 1140 17th Place
City: Vero Beach State: FI
Zip Code: 32960 Fax:
Phone No772-453-7219
E -Mail cs@myflrooflngcontractor.com
State or County License CCC1 326546
it value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
�IJPP��iA Ci�iRi{;'t� IAN NaRi"A`'t
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 1 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
O OWNER: Your ' re to Record a Notice of Commencement may result in paying twice for
;WARNI
e ublic records of St.
rove ents to, rop y. A Notice of Commence st be rec deJq'btai�rn
Lucie C my a o ted on a jobsite before the firs ' pecti . If you in financing, consult
with I der an at me fore commencin wor r r cor ' our a ofmencement.
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3 4 N W W, 9 4A Afflmov-
Si re f er/ sse ntractor as a or Owner Sign re of o ractor Lic ode ( _W V
S TE OF FLORIDA STA OF FLORIDA
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ccOF -,c+. tir COUNTYOF
Swo (or affirmed) and subscribed before me ofSwot to (or affirmed) and subscribed before me of
Physical Pres oce or Online Notarization v' Physical Presence or Online Notarization
this .� day of , 2020 by this 3 day of.`p:: 2020 by
e.`st 'e—'s "1 .'' 0_1 ' D—e. S
Name of person making statemenA Name of person making statem nt.
Personally Known 7' OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
f ,
C� J
(Signature of Notary Public- Sta a of Florida) (Signature of N I' -
teofFl�orida
Notaublic State,da
Commission No. (Seal) Commission No n H Esty k
My Commission GG OM79
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE MA GROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
le—v,3/6/20
JOHN & ANITA POLK
5706 E Seminole Rd, Fort Pierce F1 xv
MY CR
R60FING
CONTRACTOR
4101"WAAAW
Quart, subtotal
Total
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$1Z632.39