HomeMy WebLinkAboutDO NOT USE -Building Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 'C� 'a a. A Permit Number:
RECEIVED
Building Permit Application
c
Planning and Development Services
Building and Code Regulation Division Commercial
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
St. Lucie oumy
Permitting
Residential
PERMITAPPLICATION FOR: C aa� ��3� '` Q.oc�- w•e�-g1
P,ROPO.SEL? IMPROVEMENT LOCATION
Address: 3103 Kingsley Dr, Fort Pierce, FL 34946
Property Tax ID #: 1432-807-0028-000-9 Lot No. 270
Site Plan Name: Block No.
Project Name: Hall Residence
DETAI;LED,DESCRIPTION OF 1NO,RK.
Tear off Shingles & Reroof Metal, install modified undedayment & 5V Crimp
New Electrical Meter Second Electrical Meter,
CONSTRUCTION i:NFORMOON:
Additional work to be performed under this permit— check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors — Pond
_ Electric _ Plumbing
Total Sq. Ft of Constructiow.1700
Cost of Construction: $ 10,200.00
_ Sprinklers _ Generator _V Roof 3112 Pitch
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic Building Height: 10
OWNERJLESSEE:.
CONTRACTOR; :..
Name Phyllis Hall & Samantha Warren
Name: Calvin Lars Christensen
Address:3103 Kingsley Dr
Company: Roof Doctors LLC
City: Fort Pierce State: FL
Address: P.O. BOx 467
Zip Code: 34946 Fax:
city: Jensen Beach State: FL
Phone No. 772-240-9954
Zip Code: 34958 Fax:
E-Mail:
Phone No 800-339-7326
Fill in fee simple Title Holder on next page (if different
E-Mail Roofdoctorsfl@gmail.com
from the Owner listed above)
State or County License CCC1326620
If value of construction is 2500 or more, a RECORDED Notice or commencement is requirea,
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
'SU!PLP N' �NTALCC
N5TRU�TfO"I��L"l �N
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 attornev before commencing work or recording our Notice of Commencement.
Signature of Owner essee/Contractor as Agent for Owner
Signature of Contractor/Lice older
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF MQ4K+IY)
COUNTY OF Martin
SworVo (or affirmed) and subscribed before me of
Pysical
Swor o (or affirmed) and subscribed before me of
Presence or Online Notarization
Physical Presence or Online Notarization
this I day of 2peby
,
this �_ day of Ili A61AQ- . 2WO by
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Calvin Lars Christensen
Name of person making statement.%`^
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Name of person making statement.
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Known Produced Identification
Personally Known OR Produced Identifica
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Personally _�R
Type of Identification
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Type of Identification ,,,,,, AMANDA
Prod ced
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Produce+'`YA'Bi'�s Natery Public
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Signature of ota Public- State of Florida
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(Signature of Notary Public- State of FI
Commission No. (Seal)
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Commission No. (Seal)
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
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MANGROVE
COUNTER
REVIEW
REVIEW
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REVIEW
REVIEW
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DATE
RECEIVED
DATE
COMPLETED
Rev.5/6/20
i IIAN
,t of Flo'
G 29940
Expire