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AIIAPPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:Permit Number:
Building Permit Application
Plonning ond Development Seruices
Buitding and Code Regulotion Division COmmefCial
2300 Virginia Avenue, Fort Pierce FL j4982
Phone: (7721 462-L553 Fax: (772) 462-1578
Residential x
PERM lT APPLICATI ON FOR: pg;Ogf
PROPOSED I M PROVEM ENT LOCATION :
Address: 5705 Travelers Way
Property Tax lD 6' 3410-503-0039-000-4 Lot No.28
Site Plan Name:Block No. A
Project Name:
DETAILED DESCRIPTION OF WORK:
Remove shingles and renail plywood. Apply self adhering shingle underlayment and install dimensionalshingles.
New Electrical Meter Second Electrical Meter
CONSTRUCTION I NFORMATION :
Additional work to be performed under this permit - check all that apply:
_Mechanical _ Gas Tank _ Gas Piping
_ Sprinklers
_ Shutters Windows/Doors _ Pond
_ Roof 5/12 p1165_ Electric _ Plumbing _ Generator
Sq. Ft. of First Floor:Total Sq. Ft ofConstrr.lis6' 1900
Cost of Construction: $ 8,000'00 Utilities: _ Sewer _ Septic Building Height;
lf value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
lf value of HAVC is 57,500 or more, a RECORDED Notice of Commencement is required.
OWNER/LESSEE:CONTRACTOR:
1r16 ms Jacqueline Kendall
Address: 5705 Travelers Way
City: Fort Pierce, FL State: _
ZiP Code: 34982 Fax:
phone Ns.772-529-6371
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: David Packard
Company . Packard Roofing & Waterproofing, lnc.
466r"rr.2182 NW Reserve Park Trace
City: Port St. Lucie State:FL
ZiP Code: 34986 pay. 772-468-9978
phone y6772468-3723
E-1y1 3 1 1
ssmith@packardroofing.com
State or County 1-;6q65sCCCA17517
SUPPLEMENTAL CONSTRUCIION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: . NoiApplicable
Name:_
Address:
City:State:
Zip: _Phone.
MORTGAGE COMPANY: * Not Applicable
Name:
Address:
City:State:
zip:Phone:
FEE SIMPLE TITLE HOLDER: * Not Applicable
Name:
Address:
City:
zip:Phone:
BONDING COMPANY: x Not Applicable
Name:
Address:
City:
zip:Phone:
owNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and inrtrll",ion ., indi.rt"d.
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 pe-rmit will authorize the permit holder to build the subiect structurewhich is in conflict withiii.iritrire.'prE;$ ;,;",,rifl,YtfprPi"llB'S#stsfi,3#li!:]i[",flx't,;ti*r,a*.r,la*l3Jsitiil6,lr,-'*#l*:itff,r,j]J6?iii,.iiiL=.i,
ln consid.eration 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 5t. Lucie Couniy Rmendinent!.
The following building permit applications are exempt from undergoing a full concurrency review: room additiong
accessory structureg swimming pools, fenceE walls, signs, screen rooms and accessory uses to another non-residential use
STATE OF FLORIDA
COUNTY OF .#. t-rt)e
Sworn to (or affirmed) and subscribed before me ofJ Physicd Presence or Online Notarization
this --ffiay ot d*"to*t I dO d-i ,2W by
l)a,Jirl?, ektrC
**Tr-, .-al5-s--.--
(Signafure of Notary BuEjs.Slale_qtElpridiJ ^ ^
Name of person making statement.
./Personally Known rl OR Produced ldentification
Type of ldentification
Produced
-op-?:Q__
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF l*- Loa.'?
Sworn to (or affirmed) and subscribed before me of/Physical Presence or Online NotarizationtnElll5av of {ruta.a/ >oxl ,2o20 by
i>r ut d ?Lu*cttz/
Name of person making statement.
-a'
Type of ldentification
Produced
(Signatirre of Notary
Commission No.
STEei.lA\itSVTh
),lotarv Pr[$gf,l)re cf ;r6ri56
Commi!;.ox: CG t-lti:4
NlvComm Exc,l; Sei l, 20il
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, )ti-ti:i{Ii*!:li1::- rtlvComm Exci'e:See l,2cil
REVIEWS MANGROVE
REVIEW
SEA TURTLE
REVIEW
ZONING
REVIEW
DATE
COMPLETED