HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
�,LLIL-
r- e c lz c L C, -= 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:
X
Address: 1083 Bennett Rd Fort Pierce FL 34947
Property Tax ID #: 2313-121-0001-000-6 Lot No.
Site Plan Name:
Project Name: 10512 Morris Tucker
DETAILED DESCRIPTION OF WORK:
Re -Roof Shingles - GAF FL10124-R28 GAF 10626-R19 4/12 Pitch
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit —check all that apply:
Block No.
_Mechanical _ Gas Tank —Gas Piping _ Shutters _ Windows/Doors _ Pond
_ Electric _ Plumbing _ Sprinklers _ Generator X Roof 4112 Pitch
Total Sq. Ft of Construction: 3200.00
Sq. Ft. of First Floor:
Cost of Construction: $ 5,167.05 Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE: CONTRACTOR: I
Name Morris Tucker
Address: 108 Bennett
City: Fort PierrP State: FL
Zip Code: 34947 Fax:
Phone No. l7(l2) 487-0971
E-Mail: rirmnrristurker0amail_com
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: Christopher Thomas
Company: Superior One Roofing
Address: 54 W Illiana St
City: Orlando Stater
Zip Code: 32806 Fax:
Phone No 407-317-6185
E-Mail FLPERMITSP.SUPERIORONEROOFING.COM
State or County License C'C.1331538
If value of construction is 2500 or more, a RECORDED Notice of Commencement is requirea.
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
MORTGAGE COMPANY: X Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: X Not Applicable
BONDING COMPANY: XNot 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
lender or an attorney before commencing work or recording our Notice of Commencement.
with
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORI
COUNTY OF . J&& 4,
Sworn to (or affirme ) and subscribed before me of Physical Presence or Online Notarization
this _L day ofJA I 20%1 by
0,,hui4bow"'r LnVW1a'J
Name of perso making statement.
Personally Known ',10 OR Produced Identification
Type of Identification Produced
(Signature of toy Public- State of Florida )
/� CASEY R ELLIS
Commission No. `1"' �$ (Seal) State of Florida - Not lry Public
Commission P HH 49915
My Commission Expires Sept. 03, 2022
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Rev 5/20/21