HomeMy WebLinkAboutBUILDING PERMIT APPLICATION All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
U L 0 F' c L' Building pp Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential X
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: 10725 S Ocean Dr#529
Property Tax ID#: 4511-502-0061-000-7 Lot No.22
Site Plan Name: Block No. N
Project Name: Holiday Out - reroof site built portion
DETAILED DESCRIPTION OF WORK:
4 sqs new roof , Site Built Portion new roof shingles
install self adhered direct deck & GAF shingles
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 _Shutters Windows/Doors Pond
_Electric _Plumbing _Sprinklers _Generator X Roof 2/12 Pitch
Total Sq. Ft of Construction: 400 Sq. Ft. of First Floor:
Cost of Construction: $ 1400 Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Mark Moller Name: Calvin Lars Christensen
Address: 10725 S Ocean Dr #529 Company: Roof Doctors LLC
city: Jensen Beach State: FL Address: PO Box 467
Zip Code: 34957 Fax: city: Jensen Beach State: FL
Phone No. E- Zip Code: 34958 Fax:
Mail: Phone No 800-339-7326
Fill in fee simple Title Holder on next page (if different E-Mail roofdoctorsfl angmail.com
from the Owner listed above) State or County License CCC1326620
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.
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 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 ney before commencing work or recording our Notice of Commencement.
Signature of Contractor-or-Owner Builder as applicable
STATE OF FLORIDA
COUNTY OF Martin
Sworn to(or affirmed)and subscribed before me of X Physical Presence or Online Notarization
this 10 day of December ,20 by Calvin Lars Christensen
_'Q_ Q�� I
Vame o person making statement.
nally Known _OR Produced Identification
Type of Identification Produced
(Signature of Notary Public-State of Florida) 17ZOZ/EZ/11 Sal1*3 Joanne M0ehen
V�J O108SOHH#w�J Notary Public
Commission No.VAsirs. 0 al) eplJOI3 Jo ems -State of Florida
:)Ilgnd ARION =Comm#HH058010
u949M ouuwf' Expires 11/23/2024
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
6COMPLETED
ev 10/12/21