HomeMy WebLinkAboutpermit applicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential x
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: reroof
PROPOSED IMPROVEMENT LOCATION:
Address: 904 Jackson Way
Property Tax ID#: 1423-802-0016-000-9 Lot No.
Site Plan Name: Block No.
Project Name: Heaton - 904 Jackson Way
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New Electrical Meter Second Electrical Meter
LC*s T R U C T1111 0 N INFORMATION'
Additional work to be performed under this permit — check all that apply:
Gas Tank Gas Piping Shutters Windows/Doors Pond
—Mechanical —
Electric Plumbing — Sprinklers — Generator ✓ /Roof 2 Pitch
.
Total Sq. Ft of Construction. 2800 Sq. Ft. of First Floor:
Cost of Construction: 28200 Utilities: —Sewer Septic Building Height: 10,
--------
7
e Mia R Heaton
Name
Name: Douglas E. Roe
ss - 505 Beachland Blvd #148
7ddress.
Address:
Company: Code Red Roofers, Inc
Address: 3341 SE Slater St
Vero Bea
itY, Vero Beach State: FL
City:
City: Stuart State: FL
Zip Code: 32963 Fax:
Phone No. 561-789-9766
Zip Code: 34997 Fax:
E-Mail: e% IX
Phone No 772-287-2829
Fill in fee simple Title Holder on next page ( if different
E-Mail permits@coderedroofers.com
from the Owner listed above)
I State or County License CCC1 326574
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: x Not Applicable
Name:
Address:
City:
Zip: Phone
State
FEE SIMPLE TITLE HOLDER: x Not Applicable
Name:_
Address:
City:_
Zip:
Phone:
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:_
x Not Applicable
State:
x Not Applicable
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
trTucture. Pleasecconith sult w thpyoiurHle Home Owners ome Owners Association taond reviewylaws or and your deed or any restrictions nts that which may arict or pply.
such
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 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
f in work or recording our Notice of Commencement.
with lender or an a LLorney be ore commenc
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA r,4i•n
COUNTY OF CAr+ h
COUNTY OF
Swor to (or affirmed) and subscribed before me of
S% o to (or affirmed) and subscribed before me of
✓
Physical Presence or Online Notarization
by
Physical Presence or Online Notarization
this dray of I� i Dn ( 202� by
this � day of Opnr i , 202q
�O�xcIaS �e
1 / )I I E
Name of person ma ing s atement.
Name of person akingstatement.
/
Personally Known " OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(§g<ature of otary Public- State oPTIoricla)
DAYNAJ, REGIS
(Si nature ofk6tary Public- StaQe�pfp� rida) DAYNAJ. REGIS
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Commission No. (rission#HHG53320
mnismn # HH 053320
Commission No. ' (0rJsOctober 14,2024
o Expires October 14, 2024
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'lFaF F �� Banded Thru Budget Notary Sery ce
9rF oe Banded TNu Budget Notary Sery m
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Rev. 5/6/20