HomeMy WebLinkAbout37022-PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
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Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Permit Number:
Building Permit Application
Commercial
Residential X
PERMIT TYPE:
PROPOSED IMPROVEMENT LOCATION:
Address:
Property Tax ID#: Lot No.
Site Plan Name: _ _ Block No.
Project Name: Re -Roof
Additional work to be performed under this permit —check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
_ Electric _ Plumbing _ Sprinklers _ Gener'ator X Roof �/ a Pitch
Total Sq. Ft of Construction: �! 3 L19 Sq. Ft. of First Floor: f
Cost of Construction: $ �� I7 d'C Utilities: _ Sewer _Septic Building Height: _
OWNER/LE$SEE:
CONTRACTOR:
Name
Name: Robert Donovan
Addres
Company: Total
Home Roofing
_
City: State: FL
Zip Code: Faax
Phone No.^ 7 V
Address: 597 Paverty
Court, Suite 40
City: Rockledge State: F
Zip Code: 32955 Fax:
Phone No 321-452-9223
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail ChriSta
throofing.com
State or County
!cerise CCC1330489
If value of construction is $2500 or more, a RECORDED Notice of Commencement is regwrea.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
Name:
_ Not Applicable
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
Address:
City:
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
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 YOUR PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WMH ynuo ! FNE!ER OR AN ATrnwNFV RFFnRF BF[ORnING YOUR NOTICE OF COMMENCEMENT."
Signature of Ow r essee/Contractor as Agent for Owner
Signature of Co r or/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF Palm RPanh
COUNTY OF Palm Raarh
The f r i g instrument was acknowledged before me
this day of 20 by
The f ng instrum��� ��_w��_a��'��'s//////cknowledged before me
thisayof20ZI by
Robert Do
Robert Donovan
Name of person making statement.
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
SON
(Signature of Notar ate d•3f LION#
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(Signature of Notary P bp1'f �93pBBB
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REVIEWS
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SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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