HomeMy WebLinkAboutPermit Application WaltonAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: - }?r; i I , .x(` ,
Ir L L- 13 U D k - --
Planning and Development Services
Permit Number:
Building Permit Application
Building and Code Regulation Division Commercial
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: 3018 W Dixie Blvd. Fort Pierce, FL 34946
Property Tax ID #: 1428-702-0814-000-1
Site Plan Name: San Lucie Plaza S/D Unit One
Project Name: Walton Re -Roofing
Residential X
Lot No.19 & 20
Block No. 42
DETAILED DESCRIPTION OF WORK: I
Re -Roofing Shingle to Metal
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 3/12 Pitch
Total Sq. Ft of Construction: 5584 Sq. Ft. of First Floor:
Cost of Construction: $ 32,480.00 Utilities: —Sewer —Septic Building Height: 12'
OWNER/LESSEE:
CONTRACTOR:
Namejoseph and Donnie Walton
Name: Rene Reyes
Address:3018 W Dixie Blvd.
Company: My Florida Roofing Contractor
City: Fort Pierce State: F L
Zip Code: 34946 Fax:
Phone No. 772-370-5766
Address:3400 43rd Ave Ste. 7
City: Vero Beach State: FL
Zip Code: 32960 Fax:
Phone N0772-453-7219
E-Mail: suzitata5@yahoo.com
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail admin@myflroofingcontractor.com
State or County LicenseCCC1326546
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 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
with lender or an attorney before commencing work or recording our Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
1,
Sig ature of Contra c i r/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF Indian River County
COUNTY OF Indian River
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
x Physical Presence or Online Notarization
x Physical Presence or Online Notarization
this 21 day of Aa�i -by
this 21 day of �w�i 4e2& by
Name of person making statements
Name of person making statement.
Personally Known x OR Produced Identification
Personally Known x OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(
(Signature of Notary Public- State of Florida)
i �i
Commission No. a� �`"r�(Sl ry Public State of Flori
1. en H Esty
My Commission GG 90847
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(Signature of Notary Pub t}P� of II
.�*ty 480 blic Stat of Florida
1 lU�' 4�1 Gi � � Carmen H Esty
�o fission No. My Cgftn0#n GG 908479
ate ' Expires 08/28/2023
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