HomeMy WebLinkAboutBuilding permit application (original)All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: L Permit Number:
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s Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: RE -ROOF
PROPOSED IMPROVEMENT LOCATION:
Address: 4416 ARECA PALM DR
Property Tax ID #: 2434-802-0020-000-7
Site Plan Name: PALINO, MARYANNE
Project Name: PALINO -- RE -ROOF
DETAILED DESCRIPTION OF WORK:
RE -ROOF SHINGLE TO SHINGLE
New Electrical Meter Second Electrical Mete`
CONSTRUCTION INFORMATION:
Lot No.
Block No.
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 V`Roof 5/12 Pitch
Total Sq. Ft of Construction: 3116 Sq. Ft. of First Floor: 1875
Cost of Construction: $ 23,400 Utilities: _ Sewer _ Septic Building Height: 1 story
OWNER/LESSEE:
CONTRACTOR:
Name Maryanne Palino (TR)
Name.KOH SCOTT KNOX
Address:8430 Hidden Pines RD
Company: KNOX SERVICES
City: Fort Pierce State: _
Zip Code: 34945 Fax:
Phone No. 772 940 6706
Address:21301 S TAMIAMI TRL, SUITE 320, PMB 132
City: ESTERO State: FL
Zip Code: 33928 Fax:
Phone No239-470-6771
E-Mail:
Fill in fee simple Title Holder on next page [ if different
from the Owner listed above)
E-Mailenoble@knoxroofs.com
State or County License CCC1 331450
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
Name:
Address:
City: State:
Zip: Phone
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT. Application is hereby made to obtain a permit to do the work and installatioh 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 your Notice of Commencement.
Si nature of Contractor/L tense Holder
gnature of Owner/ Lessee/Contractor as Agent for Owner-
STATE OF FLORIDA
STATE OF FLO 1DA
COUNTY OF L_e-e-
COUNTY OF
Sworn to(oraffirmed) and u scribed before me of
Ph sical Presence or Online Notarization
Sworn to y (or affirmed) and su cribed before me of
Physical Presence or Online Notarization
this �' clayof_MaLA 202# by its
this Z% day of May 202# by
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KOU �S K PDX
Name of person making atement. t
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature of Notary Pu rAf f�btjl+c - state o� =.�rica
(Signature of Notary Public- Stat d' f lad )Notary Public - state o` -.a
COmmission x i i 124501
=.; veF Commission r -4-1 12450
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 5/b/ZU