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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: 1`70a.
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
PROED IM,PRO�/EMEN L T OCA
POS TION
Address: 275 Nettles Blvd., Jensen Beach
Legal Description:
Nettles Island Inc, A Condo-Section II Parcel 275 Andprorata Share in Common Elem
i
Property Tax ID#: 4502-501-0461-000-0 Lot No.
Site Plan Name: Block No.
Project Name: Bouma Residence
Setbacks Front Back: Right Side: Left Side:
DETAILED,DESCRIPTION OF WORK V
_U 7
Y
Replace old shingle roof with new metal 5v roof on sloped.
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CONSTRUCTION IN1=0RMATION`'. x
is Additionalwork to be performed under this permit—check all that apply:
_HVAC _Gas Tank —Gas Piping _Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers _Generator Roof 4/12 Roof,pitch
Total Sq. Ft of Construction: 1'029 Sq. Ft.of First Floor: 779
Cost of Construction:$ 6,680.00 Utilities: _Sewer _Septic Building Height: 1 Story
OWNER LESSEE x CONTRACTOR h>
/_ M
- a
Name eorge ose t5ouma Name: Joseph Shy der
Address:275 Nettles Blvd. Company: Seaside Hooting, Inc.
City: Jensen Beach State:_ Address: Jack James Dr., Unit A34957 it
Zip Code: Fax: City: StUa State:
Phone No. 3 Zip Code: 34997 Fax: 283-54'fl
E-Mail:Gr OUma JUnO.COm --772) 283_9599
Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail: Joe(Oseas) eroo Ing.ne
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
' I
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address- Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLEHOLDER: _Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
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 ancovenants 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 jobsite
before the first inspection. If you intend to obtain financing,consult with lender or an attorney before
commencing work or recording your Notice of Commencement.
Signature of 91F/Lessee/q ractor as Agent for Owner Signature of Co gfor/Licen-se)folder
STATE OF FLORIDA .,., STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this I day of Erbi./a.,,o 20 Eby this--L day of Pi5t/✓(,/ 20 _U by
(Name of per nowledging) (Name persorVWckno-wledging)
(Sigifaturall:KNotary Public-State of, orida) ina-Tur—e of Notary Public-State of Florida)
Personally Known__ZOR Produced Identification Personally Known �OR Produced Identification
Type of Identification Produced Type of Identification Produced
,7P.1b tat'
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Commission N 00—fSt N—qr eubrc SW WiQrfd, Commission No. Offf!Ao Fle f Pubftc a
=Gregory EkNoII 4V-6,
MM MJ'W. j�W.j Gregory E:N011
MY Commission FF 951742 My Commission FF 9617942
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Revised 07
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TU RTLE MANGROVE
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DATE
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