HomeMy WebLinkAboutBuilding Permit Application i
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: O1 a.61 11 Permit Number:
RECEIti'-:D SEP 2 0 2017
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 X
PERMIT APPLICATION FOR: Roof p
PROPOSED IMPROVEMENT LOCATION: NJ
Address: 30 AZUL LN
Legal Description: See attached
Property Tax ID#: 1301-111-0001-000-5 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Install metal roof 9veY'e>istrhg>hi<J roof 1800 SQ FEET ON A 2/12 oP('
CONSTRUCTION INFORMATION:
Additional work to e nertormed under this permit—check a apply:
E1HVAC DGasT' ank Gas Piping _Shutters Q Windows/Doors
11 Electric ❑ Plumbing Sprinklers F Generator P1 Roof 2/12 I Roof pitch
Total Sq. Ft of Construction: 1800 S . Ft. of First Floor: 1800
Cost of Construction:$ 10,500.00 Utilities:cn Sewer Septic Building Height: 12
OWNER/LESSEE: CONTRACTOR:
Name BUTCH LANDRY Name: Jon ASHENBACK j
Address:30 AZUL Company: Atlantic Construction and Roofing
city: Fort Pierce State:FL Address: 4888 N Kings Highway#229
Zip Code: 34951 Fax: City: State: FI
Phone No. Zip Code: 34951 Fax: 772-264-0302
E-Mail: Phone No. 772-215-3306
Fill in fee simple Title Holder on next page(if different E-Mail: JASHENBACKCCGMAIL.COM
from the Owner listed above) State or County License: CCC-057-852
I
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
'I i
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name:BUTCH LANDRY Name:Jon ASHENBACK
Address:30 AZUL LN Address: 30 AZUL
City: Fort Pierce State: City: State:'
Zip: Phone . Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
Address:4888 N Kings Highway#229 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 your paying twice for
improveme is to your property. A Notice of Commencement mu t be recorded and posted on the jobsite
before the i st inspection. If you intend to obtain financing, cons' It with lender or an attorney before
commenci work or recording our Notice of Commencement.
Signature of O%IDA
/Lessee/Contractor as Agent for Owner Signature Co tractor/License Holder
STATE OF F STATE Olf FLORIDA
COUNTY OF S }- COUNTY F 5!i- .
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of 20AI by this4Z day of St 0-�_ 20�a by
_ o-g\ 'o s)r,'Z. ".b a-ok o Sing Vn)a Ck
Name of person making statement Name of person making statement
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced . L
(Signature of Notary Pu - (Signature of
P A,, DEANNA MARIE GIVENS ;�.q?:°�s� DEANNA PdARIE GIVENS
i ION#GG 02202
Commission NO. MYCQ' T� � 2020 Commission N � OMPdISSION#(&re 029
E C ES:D cember 16, ES:Decembe
public underwriters r 16,2 20
%'rt•••••op� Sonded M.Notary '.,OFF;,. Bonded Thru Notary Public UndervdtenJ�1
I
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17
I
i