HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
V4 Wo [9
Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1S78
Residential X
PERMIT APPLICATION FOR: RE -ROOF
PROPOSED, IMPROVEMENT LOCATION: ' - -«•
Address:
Property Tax ID #:
Site Plan Name:
Project dName:
DETAILED DE5CR1PTfON OF WORK:::
New Electrical Meter Second Electrical Meter
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 o Plumbing _ Sprinklers _ Generator Roof 3i12 Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: _Sewer _Septic Building Height:
(OWNER/LESSEES
GON'RACTOR:
Name
Name: Donald Bouchard
Address:
.Company:-RoofClaim com
Address; 1600 Roberts Blvd Suite112
City: State: �.
Zip Code: Fax: Ii
City: Kennewsaw State: GA
Phone No.
Zip Code: 30144 = Fax: N/A
E-Mai!:
Phone No 407-278-7788
Fill In fee simple Title Holder on next page ( if different
E-Mail Permit@ROOfClaim.Com
State or County License CCC1332081
from the Owner listed above)
If value of construction is 2509 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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SUPp�EM �;� AL ONSTRUCTION LIEN.LAW,INFOWAT(ON:
DE5IGNER/ENGINEER:
Name: Not ApOcible MORTGAGE COMPANY: x Not Applicable
Address: Name:
City: Address:
7Jp• State: City: -State,.
Phone Zip: Phone,
SIMPLE ilTi lr IiQEDER• x Not App
Nalicable
Name; .."
Address:
City:
------
Zip: � phone -
BONDING COMPANY: x NotA::niirab'e
Name:
Address:
City-_
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 Count� make no representation that Is granting a permit will au orize the permit holder to build the subject structure
which Is in conflict wit any applicable Home Owners Association rules., by�aws or ancovenantsthat 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 perml% I do hereby agree that I will, in all respects, perform the work
in accordance with the approved plans, the Florida Bullding 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 thrice for
improvements to your property. A Notice of Commencement most be recorded in the public records of St.
Lucie County and pasted on the Jobsite before the first Inspection. If you intend to obtain financing, consult
with lender or an attornev before commenting work or recordir.e vour Native of Commencement,
x
_Z
Signature of Owner/1.essee/Contractor as Agent for owner signq(urp of ontrac:cr/license
STATE OF STATE
FLOR
COUNTY OFFLORID
a. .{_1CieA ( COUNTY Off_ lt7AL
Sworn to for affirmed) and subscribed before me of
"S Physical Presence or _ Online Notarization
th Zs L day of 202 f by
Name of person making statement.
Personally known OR Produced identification
Type of Identification
Produced_ I)L
Sworn to (or affirmed) and subscribed before me of
iS Physical Presence or Online Notarization
thisZtfday ofr 2021 by
Name of person making statement.
Personally Known ___� OR Produced identification
"type of Identification
Produced
(5i natureofNotaryPu (�o y ,CrFfOS&�)PHANY hUIL ,t nature of PUbilc
g ( $ Notary i _dry Public 5tat8 of
,tdotnry Public -State ffor3do eCommission # HH ii
'c Corr1�p„�s���iGa # HH 105E3$f3 ,vim d,
CommIsslon No. M1ryr Rt,missian Expiros Commisslon No, .� COMmission Ex
n ""^" March 18. 202f P :''t March tEi, 2025
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEAi1JRTlE MANGROVE
COUNTER REVIEW REVIEW i REVIEW ftEView REVIEW REVIEW
EIVEO
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