HomeMy WebLinkAboutJerome ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 0 - ZO, - 2_0 Permit Number:
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
I PERMIT APPLICATION FOR: Roof I
Address:
Legal Description:
U
Property Tax ID #: 3402 -, L 10 - (),0153 - cCc - Lot No.
Site Plan Name: Block No. ri
Project Name:
Setbacks Front Back: Right Side: Left Side:
Total Sq. Ft of Construction:
Cost, of CoConstruction.;.0( Utilities
Name , 3M=
Address: (001s C(IMI-ree Id ..
City: -P-'- + P i et rc e State:
Zip Code: 3JOR-7- Fax:
Phone N
E - M a i 1:
Fill in fee simple Title Holder on ndit page (if different
from the Owner listed above)
Sewer I
Septic Building Height:
Name: Jamie Cisco
Company: Sunshine Roofing, LLC
Address: PO Box 1083
City: Palm City
Zip Code: 34991 Fax:
Phone No. 772-260-8195
E-Mail: sunshineroofingllc@gmaii.com
State or County License: CCC1327796
if value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
State: FL
Name:_
Address:
City: —
Zip:
Phon
FEE SIMPLE TITLE HOLDER:
Name:
Add ress: PO Box 1083
City:
Zip: Phone:
_ Not Applicable I MORTGAGE COMPANY: _ Not Applicable
Name: Jamie cisco
State:
_ Not Applicable
Address:
City: Palm City State:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
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 jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
Cnmman-rinor wnrk nr rperwding vnur Notice of Commencement.
onature
wne Lessee/Contractor as Agent for Owner
Signature of Cont actor/License Holder
STATE OF FL RIDA
"
STATE OF FL R `
VA' C-\
COUNTY OF iJ-.. t t")
COUNTY OF
The f ng inst ment was acknowled d efore me
May "^..
Th oing instrument was acknowledg before me
}day t
this of -- _ 20 Y
thist of y
Name of person making statement
Name of person m lying statement
Personally Known OR Produced Identification
-Personally Known OR Produced Identification
Type ""-f Iceica�fi-bn,Type
of Identification
Prod ced
Produce _
4
r
(Signature of Notary Public -State of Flori
(Signature of Notary Public- State offlf cla )
CommisEDYE (Seal)
* * #
Commissio MWEDIseal
? t
Ids2023
1'It
BORES- Deoember m t
%"4.•a. P
REVIEWS
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
FRONT
ZONING
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17