HomeMy WebLinkAboutBuilding permit appAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 3-16-2021 Permit Number:
° Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial
Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: RE ROOF
PROPOSED IMPROVEMENT LOCATION:
Address: 6007 Petticoat PL FORT PIERCE
Property Tax ID #: 3410-503-0331-000-1
Site Plan Name:
Project Name:
Lot No. 31
Block No. K
DETAILED DESCRIPTION OF WORK:
REMOVE SHINGLE
INSTALL PEEL & STICK FL2569
INSTALL SHINGLE FL10674 INSTALL RIDGEVENT NOA No. 19-1217.03
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
_ Generator Roof ,' ! Pitch
Total Sq. Ft of Construction: 2,439
Sq. Ft. of First Floor: 2,439
Cost of Construction: $ 10,000 Utilities: , Sewer _ Septic Building Height: 8 FT
OW N ERAESSEE:
CONTRACTOR:
Name Eric Rubin
Name: ROLAN❑ WILEY
Address: 6007 Petticoat PL
Company: SHORELINE ROOFING
City. FT PIERCE State: L
Address: SW GLENDALE STREET
Zip Code: 34982 Fax:
PORT ST LUCIE
City: PState: FL
Phone No.
Zip Code: 34987 Fax:
Phone No 772-260-9565
E-Mail:
SHORELINEROOFING@YAHOO.COM
Fill in fee simple Title Holder on next page t if different
E-Mail
from the Owner listed above)
State or County License CCC1331170
If value of construction is 2500 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:
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 con currency 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 jobsite before the first inspection. If you intend to obtain financing, consult
with lender or an attornev before commencine work or recording your Notice of Commencement.
'At'o
Signaturtur Owner/ Lessee/Contrwor as Agent for Owner
Signature of Contractor/Licensd Molder
STATE OF FLORID
1a)"
STATE OF FLORIDA r.-a
COUNTY OF u
COUNTY OF
Swot to (or affirmed) and subscribed before me of
r'
Swo'c4 to (or affirmed) and subscribed before me of
Physical Pre. ce or Online Notarizeion
this}� day of i - _ 2+3�� b�
Physical Prese a or Online Notarizati(Ln
this ; rday of i 2021by �_
Name of person making statement a
Name of person making st-atemet t. o
Personally Known OR Produced Iderift for
Personally Known f OR Produced Identifi&&&& 03 ^
Type of Identification "
Type of Identification n
Prc4uced .rod
Produced _ r
(Signature of ry Public- State of Florida i .
(Signature of 1`920ry Public- State of Florida
(SC
Commission No. �' -' A-) (Seal)
Commission No. ! (Seal)
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