HomeMy WebLinkAboutBuilding permit application s
ALL 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: 6805 Donlon Rd
Legal Description: Lakewood Park unit 11-BLK 137 Lot 25 Map 13/12N) (OR 3738.663)
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Property Tax ID#: 1301-613-0025-000-0 Lot No.
Site Plan Name: Block No.
Project Name: Velez
Setbacks Front Back: Right Side: Left Side:
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DETAILED DESCRIPTION`OF WORK:
6D& Qkt 1.;6 (NiY1
CONSTRUCTION INFORMATION:
Additional work to be oertormed under this permit—check all apply:
0HVAC Gas Tank ❑Gas Piping _Shutters ❑Windows/Doors
11 Electric ❑ Plumbing OSprinklers Generator Roof 3 Roof pitch
Total Sq. Ft of Construction: S . Ft.of First Floor:
Cost of Construction:$ Utilities:n Sewer Septic Building Height:
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OWNER/LESSEE: CONTRACTOR:
Name Juanita or Carlos Velez Name: Mathew Drozd
Address:6805 Donlon Rd Company: Diversified Roofing Solutions, Inc
City: Fort Pierce State:FL Address: 1194 Old Dixie Hwy Ste 17
Zip Code: 34951 IFax: City: Lake Park State:F�
Phone No. Zip Code: 33403 Fax:
E-Mail: Phone No. 561-841-5676 j
Fill in fee simple Title Holder on next page(if different E-Mail: geris@diversifiedroofingfl.com
from the Owner listed above) State or County License: CCC1330205
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If value of construction is$2506'or more,a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: v
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:
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I certify that no work or installation has commenced prior to the issuance of a permit.
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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 Commenceme t may result in your paying twice for
improvements to your property. A Notice of Commencement must b recorded and posted on the jobs,ite
before the rst ' s ection. If you intend to obtain financing, c nsu t ith lender or an attorney before
commenci ' w k r recording our Notice of Commencemerit.
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Signature of bte /Contractor as Agent for Owner SignatdrA of Wtracto License Holder
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STATE OF FLORIDA STATE OF FLO
COUNTY OF Palm Beach COUNTY OF Palm Beach
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The fo going instr.�Lwent was acknowledged before me The forgoing instrument was acknowledged-before me
this day of 20 by this " day of January 20 �by
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Mathew Drozd
(Name of person ackn dgin (Name of person acknowle ing)
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(SigAilfure of Notary Pu lic-State of Florida ) (Signs ure of Notary Public-State of Florida)
Personally Known OR Produced Identification Personally Known x OR Produced Identification
Type of Identificatio duced Type of Identification Produced
' 4;: GERI AUEERT Commission No. ;.?"fir' 'i1. GE t�S HUBERT
Commission No. : ; MY C0M};�ISS ON#G0006600
�. COMMI SIGN#GG008600 �•J
fa EXPIRES October 07 EXPIRES October 07,2020
FWWNotoryS@pW,-c= (407)398.0153 Flondallotary$MM.tom
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE �r}
INITIALS
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