HomeMy WebLinkAboutWalton - Application - NotarizedAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 05/07/2021 Permit Number:
- � M I � ,rws ,. n. r ,
t r� ' :.+� L^ rti _-`" Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential XX
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: Re -Roof
PROPOSED IMPROVEMENT LOCATION:
Address: 6508 Flora Way, Ft Pierce, FL 34951
Property Tax ID #: 1301-607-0209-000-5 Lot No. 6
Site Plan Name: LAKEWOOD PARK -UNIT 7- BLK 78 LOT6 (MAP 13/02N) Block No. 78
Project Name: Walton, Phyllis - Roof
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DETAILED DESCRIPTION OF WORK:
Remove existing roof down down to decking. Install self -adhered membrane. Install 5V 24 ga galy roof.
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 5/12 Pitch
Total Sq. Ft of Construction: 3,000 Sq. Ft. of First Floor: N/A
Cost of Construction: $ 18,535.00 Utilities: —Sewer _Septic Building Height: `12' avg
OWN ER/LESSEE: CONTRACTOR:
Name Phyllis Walton
Name: Jason Morar —
Address: 6508 Flora Way
Company: Southern Roof Systems, Inc
City: Fort Pierce State:
Zip Code: 34951 _ Fax:
Address: 2685 SW Domina Rd
City: Port Saint Lucie State: FL
Phone No. 772-579-5572
Zip Code: 34953 Fax:
E-Mail:
Phone No 772-324-9613
Fill in fee simple Title Holder on next page ( if different
E-Mailjason@southernroofsystems.com
State or County License CCC1332470
from the Owner listed above)
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.
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SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: — Not Applicable TN2me:
ORTGAGE COMPANY: — Not Applicable
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
that
or or any aprohibit such
in tiand yyour which maor
structure. Pleaslecconsult w thpypoiur,Hlome Owners Association reviewdeed fws ronts e trict
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
Commencement must be recorded in the public records of St.
improvements to your property. A Notice of
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 rec rdin our Notice of Commencement.
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Sign ure of Owner Lessee/Contrac or as Agent for Owner
Signatur of Contrac o icense Holder
STATE OF FLORID
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STATE OF FLORID L.� �' JL
COUNTY OF_ A
COUNTY OF • V
Swornjo (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
-�PFysical Presence or Online Notarization
this 1 day of r'r---) C1 202$ by
this J I day of 2020 by
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Name of person making statement.
Name of person making statement.
Personally Known z/OR Produced Identification __
Personally Known _ FOR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
z
(Signs ure of Notary Public- State of Florida)
(Signature of Notary Public State of Florida)
1 (Seal)
Commission No. is (Seal) S
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Commission No. S.SLI.SL 1
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
REVIEW
MANGROVE
REVIEW
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 576770 -_