HomeMy WebLinkAboutapplication 5612.pdfAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
Cal v >, C: c L L t; -1' , Building 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: RE ROOF
PROPOSED IMPROVEMENT LOCATION:
Address5612 Cassia Dr Fort Pierce, FL 34982 /INDIAN RIVER ESTATES-UNIT-09- BLK 79 LOT 1 (MAP 34/12NOR 3418-20-
Property Tax ID #: 3402-610-0266-000-8 Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
RE ROOF ASPHALT SHINGLES 14005OFT
tear -off shingles, install new shingle over
synthetic underlayment
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 XRoof 4/12 Pitch
Total Sq. Ft of Construction:
Sq. Ft. of First Floor:
Cost of Construction: $ 12,170 Utilities: —Sewer —Septic, Building Height:
OWN ER/LESSEE:
CONTRACTOR:
Name Russell A Schroeder
Name: _ 111 IAN VARFI A
Address: 5612 Cassia Dr
Company: BUILDERS 360 INC
Fort Pierce, FL 34982 State: -
City:
Address: 12811 SUGARWOOD LN
Zip Code: Fax:
City: CLERMONT State: FL
Phone No.
E- Zip Code: 3471 Fax:
786.333.
Mail:
144
Phone No
Fill in fee simple Title Holder on next page (if different
E-Mail
from the Owner listed above)
State or County License ccc1332008
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.
'ticannea witn uambcann
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
MORTGAGE COMPANY:
Name:
Add ss•
DESIGNER/ENGINEER:
Name:
Address: _
City:
Zip. Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
r'i tv-
Zip: Phone: _
Not Applica
State:
Not Applicable
Not Applicable
I e State:
City:
Zip: Phone:
BONDING COMPANY:
Name:
Address:
City:
Zip, Phone:
Not Applicable
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 1 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 lobsite before the first inspection. If you intend to obtain financing, consult
with lender or aryattorpey kefore commencing work or recordiag your Notice of Commencement.
Signature of tra r- r-Owner Builder as applicable
STATE OF LORI A
COUNTY OF �-�-
Sworn to (or affirmed) and subscribed before me of ✓ Physical Presence or Online Notarization
this -- day of :2 r . 20Z-Z by
i. 1 1 G, N l l?t Q_f� f
Name of person making statement.
Personally Known � OR Produced identification
Type of identification
(Signature of Notary Public- State of Florida)
Commission No. V("0 kl -(O (Seal)
REVIEWS
RECEIVED
DATE
COMPLETED
- No RBsfyAA eiDOlM All
; 3 Commission M GG 922160
my Commission Expires
October 13. 2023 11
FRONT COUNTER I ZONING REVIEW 1 SUPERVISOR REVIEW I PLANS REVIEW I VEGETATION EVIEW� S REVIEW l 'MANGROVE
"'-zscannea wim uamzscann