HomeMy WebLinkAboutBuilding Permit AppAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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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: RE -ROOF
PROPOSED IMPROVEMENT LOCATION:
X
Address: 2573 Lucy Ln Fort Pierce, FL 34981
Property Tax ID #: 3405-802-0001-000-1 Lot No. 1
Site Plan Name: Hudson Residence Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
RE -ROOF SHINGLE TO SHINGLE
TEAR OFF EXISTING ROOF INSTALL NEW UNDERLAYMEN T AND 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 4/12 Pitch
Total Sq. Ft of Construction: 1900 Sq. Ft. of First Floor: 1900
Cost of Construction: $ 13,400 Utilities: Sewer _ Septic Building Height: 11 FT
OWNER/LESSEE:
CONTRACTOR:
Name Deborah Hudson
Name: Andrew Keys
Address: 2573 Lucy Ln
_ _
Company: FoxHaven Roofing Group
City: Fort Pierce, State: FIL
Zip Code: Fax:
Phone No. E-
_
Address: 1055 SE Holbrook Cir #5,
City: Port St. Lucie, State: FL
Zip Code: 34952 _ Fax:
Phone No 772-249-4954
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail andV a0fnxhavanrnnf cnm
State or County License CCC133163S
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 Applicable
Name:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City: State:
Zip: Phone:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
Zip: Phone:
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 our Notice of Commencement.
Signature of Contrac r - 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 24th day of January 20 22 by
Name of person making statement.
Personally Known X OR Produced Identification
Type of Identification Produced
Sawli a 6011oaGez
(Signature of Notary Public- State of Florida)
f ' SAMIRA W CONZALU
Commission No. GG197318 (Seal) r# 1 MauyP*t-swroffbrw
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Rev 10/12/21