HomeMy WebLinkAboutPatterson permit application form.pdf ST. LUCIE
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ST LUCIE COUNTY ROOFING PERMIT INFORMATION SHEET
Florida Building Code 7th Edition (2020)
Based on Section 1525 of the Florida Building Code-Building
INSTRUCTION PAGE
COMPLETE THE NECESSARY SECTIONS OF THE UNIFORM ROOFING SHEET
APPLICATION FORM AND ATTACH THE REQUIRED DOCUMENTS AS NOTED
BELOW:
Required Sections of Attachments Required
Roof System the Permit Application See List Below
Form
Low Slope Application A,B,C 1,2,3,4,5,6,7
Prescriptive BUR-RAS 150 A,B,C 2,4,5,6,7
Asphaltic Shingles A,B,D 1,2,4,5,6,7
Concrete or Clay Tile A, B,D,E 1,2,3,4,5,6,7
Metal Roofs A,B, D 1,2,3,4,5,6,7
Wood Shingles and A,B, D 1,2,4,5,6,7
Shakes
Other As Applicable 1,2,3,4,6,6,7
ATTACHMENTS REQUIRED As Applicable):
1. Fire Directory Listing Page
2. From Product Approval:
Front Page
Specific System Description
Specific System Limitations
General Limitations
Applicable Detail Drawings
3, Design Calculations per Chapter 16,or if applicable, RAS 127 or RAS 128
4. Other Component of Product Approval
5, Municipal Permit Application
6. Owners Notification for Roofing Considerations(Reroofing Only)
7. Any Required Roof Testing/Calculation Documentation
Form RooflnfoFeb21 Rev Feb 18,2021
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: I O I2���� Permit Number:
T
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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 CBDG Funding
PERMIT APPLICATION FOR: ki tx- Q06T
PROPOSED IMPROVEMENT LOCATION:
Address: -i�9 ---3 rbr k rrrniyt RX Forl pier-re tf-L 3U4q5
Property Tax ID B: .2377 -3y 3 - 0005--Ooo -,Y Lot No.
Site Plan Name: ///J� /�" Block No.
Project Name: �affierson K•t1,lt�((,7?ce
DETAILED DESCRIPTION OF WORK:
6eY fl2iirg�p 9j// "✓N PkfSt1Y1G r/Xlir*utfnmd0uyl ID �/rawn,n/c(cFre-nadforodi
it tll wti�e azt�li Je G sell'� dlweof to coati 6t"11 %W1* 1W9r ,:uP*/ aly '0i' ePd
.; e c ( 1pll S"ft
pn ries»+// a► rd rriInnyy (rule Yo cad. .wrnRjdrrs s tr Mimi r re^, .
ew lec rical fvl'eter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit-check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters Windo
tor Roo s/Doors _Pond
Plumbing_Electric _ _Sprinklers _Generaf Pitch
Total Sq. Ft of Construction:J;nn Sq. Ft. of First Floor: / e12
Cost of Construction: $ 171 &66 •Y(� Utilities: —Sewer Septic Building Height: 12-
OWNER/LESSEE: CONTRACTOR:Name F I L R �'O// Name:- QSE-PVI Gw jI mSIf-
Address: Company: 063hoi'F 2Bolin
City: dqiYA Qe/cF State: FG Address:eS ?'0 SF. (YaUveJ GtJE Zip Code: Wfjf,S Fax: City: k Ii'g(t State:Phone No. 't3057 E- ZipCode:,3t[�q Fax:
Mail: Phone No
Fill in fee simple Title Holder on next page(if different E-Mail ort /6 d YY1
from the Owner listed above) State or County License CC.Cd4
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.
SUPP,,EN�ENTAL QONSTRVCTIOIV LIEN LAW;I.NF,ORMATION
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: P e:
FEE SIMPLE TITLE ER: Not Applicable BONDING MPANY: Not Applicable
Name: Name•
Address: A ess•
City: ity:
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 conflicts with any,applicable Homeowners Association rules,bylaws or and covenants that may restrict or prohibit such
structure.Please consult with your Homeowners 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 our Notice of Commencement.
/I,- r7�:) .
Signat re of ractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF 16M&
n subscribed before me of Ph Physical Presence or Online Notarization
Swort�,,,o.,,��r affirmed d subsc be e y
this2T'day of off" 20,W by
Name of person making state ent.
�> dp THOMAS W.STEVENS
Personally Known OR Produced Identification Commission#GG 366991
Type of Identificati Produced :p Expires October 9,2023
Bondud Thru Troy Fain insuranco 800-385-7019
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(Sign at f Notary Public-State of Florida)
Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev 5/20/21