HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
1E LLLy EE
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Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: RE -ROOF
PROPOSED IMPROVEMENT LOCATION:
Address: 7913 PLANTATION LAKES DRIVE PORT SAINT LUCIE FL 34986
Property Tax ID #: 3321-801-0063-000-3
Site Plan Name:
Project Name: GEORGE SHAAL
DETAILED DESCRIPTION OF WORK:
REMOVE EXISTING TILE ROOF
Residential X
Lot No.63
Block No.
INSTALL POLYSTICK TU MAX DIRECT TO DECKIINSTALL BORAL SAXONY 900 USING ICP TILE FOAM ADHESIVE
REPLACE TWO SKYLIGHTS AND INSTALL 2 ATTIC BREEZE VENT
New Electrical Meter Second Electrical Meter
CONSTRUCTION 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
Total Sq. Ft of Construction:
Cost of Construction: $ 5C)i
Generator X Roof Pitch
Sq. Ft. of First Floor:
Utilities: —Sewer _ Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
NameGEORGE SHAAL
Name:JOSHUA SCHROEDER
Company: MARZO ROOFING INC
Address:7913 PLANTATION LAKE DRIVE
City: PORT SAINT LUCIE State: _
Zip Code: 34986 Fax:
Phone No.302-229-8539
Address:861 SW LAKEHURST DRIVE
City: PORT SAINT LUCIE State: FL
Zip Code: 34983 Fax:
Phone No772-871-2489
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-MailMARZOROOFINGINC@GMAIL.COM
State or County License
If value of construction is 2500 or more, a RECoftutU Notice oT eommencement is requ,reu.
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: 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 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 payin ice for
improvements to your ertW.Agticeof Commencement must be recordedin e p blic records of St.
Lucie County and ed onte before the first inspection. If yo obt 'n financing, consult
with lanrlar n n attnrn fnrP nmmencin� work or recordine v r Notic f Co encement.
Sign 1-e"of owner/ Lessee/Contracto s gent for Owner
o Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OFSLC
COUNTY OFsLC
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
x Physical Presence or Online Notarization
x Physical Presence or Online Notarization
this 8 day of JANUARRY ,,202Q by
thisthis 8 dayof JANUARY 202'� by
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Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification x
Personally Known OR Produced Identification x
Type of 1 entification
Type o Identification
Produce LICENSE
Prod u dLIC NS
P
(Sig.pKature o of ut - tat4oQ��YF g6fAt1Bte of Florida
(gyte of Floridae
Si nature of N tar Pani
ADOLI MIRONCHUK
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Commission No. Y I W
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Commission No.21 9as31
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21
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Rev. 5/b/ZU