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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 6/8/2017 �-���/� Permit Number: //U�
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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
PERMIT APPLICATION FOR: Roof
PROPOSED IMPROVEMENT LOCATION:
Address: 175 SE FLORESTA DR. PORT SAINT LUCIE FL 34983
Legal Description: RIVER PARK-UNIT 4 BLOCK 38 LOT 14 (MAP 34/28N)
Property Tax ID#: 341953001650007 Lot No. 14
Site Plan Name: Block No.
Project Name: FLORESTA
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
TERAING OFF OLD ROOF AND INSTALLING A NEW ONE, INCLUDING THE FLAT DECK.
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CONSTRUCTION INFORMATION:
Additional work to be Q rformed under this permit-c ec a apply:
1_1HVAC Gas Tank Gas Piping _Shutters ❑Windows/Doors
❑Electric ❑ Plumbing Sprinklers Generator 121 Roof /Z Roof pitch
Total Sq. Ft of Construction: 1800 S Ft.of First Floor:
Cost of Construction: $ lJ� 6Sz. Utilities:cnSewer Septic Building Height: 11'
OWNER/LESSEE: CONTRACTOR:
Name JJJ AND W INC Name: PHILIP BLAKE
Address: 175 SE FLORESTA DRIVE. Company: BLAKE BUILDING CONSTRUCTION
City: PORT SAINT LUCIE State: FL Address: 16610 NORTH PL.
Zip Code: 34983 Fax: City: LAXOHATCHEE State. FL
Phone No. Zip Code: 33440 Fax:
E-Mail: Phone No. (561)420-3733
Fill in fee simple Title Holder on next page (if different E-Mail:
from the Owner listed above) State or County License: CCC1327025
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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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:
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 y u intend to obtain financing, consult 'th lender or an attorney before
commencingwork or re rd our Notice of Commencement.
s
ignature of Owner/Lessee/Contractor as Agent for Owner Signatur of Contract r/License older
STATE OF FLORIDA � __�� STATE OF FLORIDA
COUNTY CIF pa 1 YV1 beCcc -� COUNTY OF_��r1�jeCr[�1
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this]-3-day of TOYle- , 20 LT-by this J_J day of SU r1 e , 20 ') by
sock Y-IA�l e ACIO me s PA&1, It,P PJ a -e
(Name of person acknowledging) (fame'of person acknowledging)
Signature of Notary Public-State of Florida ) (Signature of Notary Public-State of Florida ) \`si1 1,T1I///"
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Personally Known —� OR Produced I", 118 NS '% Personally Known OR Produced Idelt c 1oNF
Type of Identification Produced c?�':�o� F ;�ZG ,Type of Identification Produced
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Commission No.r-P 0037-f.S ('Seel) commission No.rt__003Z¢5 See: ��3245 H:_o
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Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
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