HomeMy WebLinkAbout5113 Palm Permit App.pdfAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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`-, 4 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
PERMIT APPLICATION FOR: Re Roof
PROPOSED IMPROVEMENT LOCATION:
Address: 5113 Palm Dr, Fort Pierce
Property Tax ID #: 3402-608-0332-000-5
Site Plan Name: NIA
Project Name:
Lot No.30
Block No. 49
DETAILED DESCRIPTION OF WORK: I
We will tear off existing roofing system, nail the deck off to current code, apply secondary water-resistant barrier,
along with architectual shingle roofing system.
New Electrical Meter NIA
Second Electrical MeterNlA
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
Total Sq. Ft of Construction: 1800
Cost of Construction: $ 8390.00
Sprinklers
Generator Roof 4/12
Sq. Ft. of First Floor: NIA
Pitch
Utilities: —Sewer — Septic Building Height: 15ft
OWNER/LESSEE:
CONTRACTOR:
Name Conrad Young
Name: Christopher Collins
Address:8113 Palm Dr
Company:Collins Roofing Inc.
City: Fort Pierce State: _
Zip Code: 34982 Fax:
Phone No.772-418-7867
Address: PO Box 12867
City: Fort Pierce State: FL
Zip Code: 34979 Fax; NIA
Phone No 772-940-8607
E-Mail:dcsyoung@gmail,com
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail collinsroofinginc@gmail,com
State or County License CCC-058011
If value of construction is 2500 or more, a RECORDED Notice of Commencement is requiretl.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: X Not Applicable
Name:
MORTGAGE COMPANY: X Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: X Not Applicable
Name:
Address:
BONDING COMPANY: X Not Applicable
Name:
Address:
City:
Zip: Phone:
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 is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners 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 concurrent Feview i m additions,
accessory structure in fences, walls, signs, screen rooms and acces y uses to anothe non-r
WARNING-f OW : our failure to ecord a Notice of Commen ment may result i ying twice for
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u ce Cou a and sted on #1 jobs oelbefore the f 5t Commencece of oect onslfv ou i ors d t�h apubnia r�ec�ortof I iY
with len r a tt efore gdmmencin work o record' our. i Com ement.
e of Owner ssee/Contractor as Agent for Owner
Signat Contractor/License Holder
STATE OF FLORID -
COUNTY OF L
STATE OF FLORI
COUNTY OF A)�,
Swo to (or affirmed) and subscribed before me of
Sworn (or affirmed) and subscribed before me of
ical Presence or Online Notarization
Physical Presence or Online Notarization
this ay of M,I rI7 202Xby
this ��y of 2027-by
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Name of person makirig statement.
Name of person making stat ment.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
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Produced_��
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(Signat re of Notar ublic- State of Flo a)
(Signature of Notary Public- State of Flor
'-'kRyk&Z Rebekah Hoy
Commission No i TARY PUBLIC
Yq Rebekah Hoy
Commission No. D Q INOTARY PUBLIC
ATE OF FLORIDA
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pires 2/17/2023
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