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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: i J 0� •,Q ) Permit Number: � ) ('� a 7
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. ®..PIP �- 2 1821
Building Permit Application Peep„
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Planning and Development Services t.' Woe AC6urYy
Building and Code Regulation Division Commercial X Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: Mainstay Suites Flat Roof Repair
PROPOSED IMPROVEMENT LOCATION:
Address: 8501 Champions Way, Port Saint Lucie, FL 34986
Property Tax ID #: Parcel #3327-708-0009-000-9
Site Plan Name: TWC Port Saint Lucie, LLC
Project Name: MainStay Suites Flat Roof Repair
Lot No.
Block No.
DETAILED DESCRIPTION OF WORK:
Remove and repair flat roof over main entrance, possible wood frame reconstruction.
New Electrical Meter N/A Second Electrical Meter N/A
CONSTRUCTION 'IWORMATION:
Additional work to be performed under this permit— check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator is Roof 0
Total Sq. Ft of Construction: 800 Sq. Ft. Sq. Ft. of First Floor:
Cost of Construction: $ 11,800 Utilities: —Sewer _ Septic
_ Pond
Building Height:
Pitch
OWNER/LESSEE:
CONTRACTOR:
Name TWC Port Saint Lucie, LLC
Name: Phil Coutu
Address: 40 W 57th St. FI 29
Company: Rooftop Roofing, Inc.
City- New York, NY State: _
Zip Code: 10019 Fax:
Phone No. 772-460-8882; Ext. 500
Address: 108 Escalona Ave
City: Pensacola state: FL
Zip Code: 32503 Fax:
Phone No 772-475-3867
E-Mail: gitownley@gmail.com
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail johnd@rooftopinfo.com
State or County License CCC1 326630/CBC1 259205
If value of construction is 25M 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: I
1 DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: __D�6t Applicable
i
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone: j
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
City:
Zip: Phone.
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
Applicable
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to co 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 1 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 undergoinga 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 job -site before the first inspection. If you intend to obta'n financing, consult
with lender or an attorney before commencing work or recording vour Notice of Comnibncement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signa re of Contra r/Lice6egolo&
STATE OF FLORIDA
STATE OF -1 --1 -►- �zzato
COUNTY OF� - L uc, -e'
COUNTY OF CCS�e�
Sword° (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
L.-' Ph ical Presence or 9mine Notarization
thishC`ay of NO}Qf1fJY _, 2020 by
Plysical Pre a es ru orOnline 1�Nota Notarization
thi _ _ day of i 020 b
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Name of person making sstaa ment.
Name of person making stat nt.
Persorally Known _ �/OR Produced Identification
_
Personally Known OR Produced Identification
Type of Identification
Type of Identification-
Produced
Produced
(Signature of tiotary Public- State
of Notary )
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Matry Public StsO�
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Commission No.6c� z1 yet)
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f onds ANN
issi iTARY PUBLIC STATE OF C({hJ�f�ADO
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MY COMMISSION
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
ROVE
VEGETATION
SEA TUR
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 5/6/20