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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED .
Date: ' `8.,b Permit Number: 01.6 \3.4) \Coq
RECEIVED
OMA DEC 0 7 2020
a ° ° Building Permit Application Permitting Department
Lucie County
Planning and Development Services St.
Building and Code Regulation Division commercial Residential xx
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578
PERMIT APPLICATION FOR:REROOF - Shingle to Metal
PROPOS'ED.IMP ROVE MENT LOCATION:
Address: 2800 Placid Ave
Property Tax ID#: 2421-234-0001-0005 Lot No.
Site Plan Name: Block No.
Project Name: Mojica Residence
DETAILED DESCRIPTION OF WORK:_
Removed current shingle roof system, inspect deck to code, install peel &stick underlayment, install new metal roof
New Electrical Meter Second Electrical Meter
C�O.NSTRUCTION INFORMATION:
Additional work to be performed under this permit—check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors . _Pond
Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction. $ O O CS Utilities: _Sewer Septic _';.'.'-Building Height:
OW1 NE=R/-ESSEE: CONTRACTOR: _: J
NameJose Guadalupe Mojica Name:NA-Owne/Builder.,
Address:2800 Placid AVe Company:
City: Fort Pierce State:_ Address:
Zip Code: 34982 Fax: City: State:
Phone No.772-519-2075 Zip Code: Fax:
E-Mail:guadapio75@gmail.com Phone No
Fill in fee simple Title Holder on next page(if different E-Ma
from the Owner listed above) St de or County License
If 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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable _MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: / Address:
City: ate: City: -- -Sta—te:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE H _ Not Applicable BONDING COMP Nf Not Applicable
Name: Name:
Address: Addre
City: Ciq:
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 paying twice for
improvements to your property. A Notice of Commencement must be recorded in the public records of St.
Lucie County and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
with lender or an attorney before commencing work or recording our Notice of Commencement.
Win
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Signature of Owner/Lessee/Co tractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORID STATE OF FLORIDA
COUNTY OF —',C\ COUNTY OF
Swor or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of
Physical Presence or Online Notarization Physical Presence or Online Notarization
thi�--'6 day of 12020 by this day of 2020 by
J3�� ('�n. " "Q cam,
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification 1/' Personally Known OR Produced Identification
Type of Ide cation "�'' ` e' -''" Type of Identification
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Signature of Not ry Public-Stat � ivwe;�a ' p�;Ia,i (Signature of Notary Public-State of Florida )
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Commission No. eal IRES:A0119,2023
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