HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 12-3-2021 Permit Number:
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L L c tL L L, iti 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-IS78 CRDG Funding
PERMIT APPLICATION FOR:. REROOF j
PROPOSED IMPROVEMENT LOCATION: _.
Address: 5802 Balsam ❑R FT PIERCE
Property Tax ID #: 3402-610-0302-000-3 Lot No. 11
Site Plan Name: Block No. $0
Project Name:
DETAILED DESCRIPTION OF WORK:
REMOVE SHINGLE ROOF
INSTALL PEEL & STICK UNDERLAYMENT FL2569
INSTALL SHINGLE FL18355 INSTALL RIDGEVENT NOA NO. 19-1217.03
New Electrical Meter Second Electrical Meter (Affidavit required)
[CONSTRUCTION INFORMATION:
Additional work to be performed under this permit —check all that apply:
Mechanical Gas Tank _ Gas Piping
_ Electric _ Plumbing
Total Sq. Ft of Construction: 2094
Cost of Construction: $
OWNERAESSEE:
12250
Sprinklers
Shutters Windows/Doors ` Pond
Generator x Roof 5112 Pitch
Sq. Ft. of First Ftoor: 10 1
Utilities: _ Sewer ! Septic Buiiding Freight: 18 FT
Name Ralph CDrvino
Address: 5802 Balsam DR
City: FQRT FIERCE State: FL
Zip Code: 34982 Fax:
Phone No. E-
mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
CONTRACTOR:
Name. ROLAND WILEY
Campany:SHORELINE ROOFING
Address:1973 SW GLENDALE STREET
City: State: FL
Zip Code: 34987 Fax:
Phone No 772-260-9565
E-Mail SHORELINEROOFING@YAHOO.COM
State or County License CCC1331 170
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
Name: _
Address:
City:
Zip:
Phone
State
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name: _
Address:
City:
Zip:
Phone:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City: State:
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 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 your Notice of Commencement.
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Signature Owner/ Lessee/Contractor as Ageritfo r Owner
STATE OF FLORIDA -
COLINTY OF
Sworpp (or affirmeA;i) and subscribed bef�re me of `f Physical Presence or Online Notarization
this day of 1.:-_!. . 2Q by
Name of person making statement.—'
r'•
Personally Known OR Produced Identification
Type of Identification Produced
(Signature of NotaryyPublic- State of Florida)
r '.`. BRANDY MOORS
Commission No. - .-_( � V .;
_� Public -State of Fictida
_NotaiV
= Commission # HH 108395
r My Commission Expires
May 09. 2025
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