HomeMy WebLinkAbout8549 Belfry Pl_Surniak_BldgPermitApp_SIGNEDAll APPLICABLE INFO MUST 01 COMPLETED FOR APPLICATION TO 89 ACCEPTED
Date: 3/12/2021 Permit Number:
'ss'�A_ LUL, LL
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: Residential Re -Roof
PROPOSED IMPROVEME-INIT'LOCATIO14:
Address- QQ'+w Dul"Y r-I., j-vrt Saint Lucie, t-L 44V?J6
� 3327-701-0046-000-9
Property Tax ID M Lot No. 43
Site Plan Name: Block No.
Project Name: Jeffrey Sumiak
DETAILED. DESCRIPTION OF WORK:
F 4A%0'0F urp 1%JV1 'aliu I= cttt;U
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 hutters Windows/Doors Pond
Electric Plumbing Sprinklers Generator Roof 6112 Pitch
Total Sq. Ft of Construction: 2875 sq. ft- Sq. Ft. of First Floor:
Cost of Construction: $ 33,885 Utilities. — Sewer _ Septic Building Height:
OWNERAESSEE':
CONTRACTOR:
Name Jeffrey gu-rniak
Name* Phil Coutu
Address: 8549 Belfry Pl.
company: Rooftop Roofing, Inc.
City: Port Saint Lucie State: FL_
Address: 108 Escalona Ave,
Zip Code, 34986 Fax:
city: Pensacola State: FL
Phone No. 772-579-9528
Zip Code: 32503 Fax:
E-Mail:jsurniak2t OO@yahoo.com
Phone No772-475-3 -7
-
Fill In fee simple Title Holder on next page (if different
E-Mail johnd@rooftopinfo.com
from the Owner listed above) .
State or County License CCC1 326630
M'V.4VV us 111VIC, a nCUV-tJCU imouce oT 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: X Not Applicable
MORTGAGE COMPANY: x Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: - phone:
FEE SIMPLE TITLE HOLDER: x Not Applicable
BONDING COMPANY: x Not Applicable
Name:
Name:
Address:
Add ress:
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 con Act 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 Cordes 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 iron -residential use
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in haying 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.
� / �i5 V�iw,
W-
SWature of ner/ lessee/Contractor as Agent for Owner
Si Cure of C ractor i ense Holder
STATE OF FLOTDA
STATE OF FLORIDA
COUNTY OF t �i i
COUNTY OF r���`'� "I
5wor o (or affirmed) and subscribed before me of
Sworn or affirmed) and subscribed before me of
Physical Presence or Online Notarization
Physical Presence or Online Notarization
this,� day of rP 2%9-by
this' �. day of M�s� - 82i by
c_i� t
Rif it V "to
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known _ OR Produced identification
Type of Identific�ton
Pro?1�t i('1 A u6' J
Type of Identific Lion
Produced
//duced
{Signature of Notary Public- State of Florida, a
(Signature of Notary Public- State of FI Calo Cardoso
Commission No. �' I L& 11`j < Notary Public
(� �� �G, �, Notary Public
Commission No, �,;,� L �- � Mate of Florida
a State of Florida
L Comm# HH025595
' �� Comm# HH025595
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SUPERVISOR
PLANS
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MANGROVE
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