HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLII;ABLf INFO MUST BE C01,,,i tET0 FOR APPLICATION TO BE ACCEPT11iiLJ
Date:' I Permit Number: Qs
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: Roof
PROPOSED IMPROVEMENT LOCATION:
Address: 6639 Picante Cir. Ft. Pierce,Fl 34851
Legal Description: SPANISH LAKES FAIRWAYS BLK55 LOT15 (OR 3697-2606)
Property Tax ID #:
Site Plan Name:
Project Name:
Setbacks Front Back:
(,,DETAILED DESCRIPTION OF WORK:
Reroof Shingle roof to 5-V metal roof
Right Side:
Left Side:
Lot No.15
Block No. 55
CONSTRUCTION INFORMATION:
Additional work to e nertormed under this permit —check a apply:
EIHVAC Gas Tank ❑Gas Piping _ Shutters Q Windows/Doors
11 Electric 0 Plumbing Sprinklers Generator W1 Roof 5�12 Roof pitch
Total Sq. Ft of Construction: 3000
Cost of Construction: $ 13500
S Ft. •of First Floor: _
Utilities:cn Sewer F]Septic
Building Height: 10ft
OWNER/LESSEE:
CONTRACTOR:
Name Denise Kuckens
Name: Roland Wlley
Address: 6639 Picante Cir
Company: Shoreline Roofing LLC
City: Ft. Pierce State: FI
Address: 1973 SW Glendale St
Zip Code: 34951 Fax:
City: Port St Lucie State: FI
Phone No.
Zip Code: 34987 Fax:
E-Mail:
Phone No. 772-260-9565
Fill in fee simple Title Holder on next page ( if different
E-Mail: shorelineroofing@yahoo.com
from the Owner listed above)
State or County License: CCC1331170
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
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 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 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 your paying twice for
improvements to your property. A Notice of Commencement must be recorded 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 vour Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/0
ontractor is rise Holder
STATE OF FLORIDA I STATE OF FLORIDA
COUNTY OF fkn-R 1��J CCJVIV 1 COUNTY OF ( Ja 0 l e—
The forgoing instrument was acknowledged before me
this I`I day of 0UGQS; , 2017 by
01:-;v> >L kJ(- KL-: r--)
Name of person making statement
Personally Known 1 X OR Produced Identification
Type of Identification
Produced
(Signature of ubkty .fiats o F �110 FORERO
�om No. .MY C04%)ON #FF133129
EXPIRES June 16, 2018
The forgoing instru ent was acknowledged efore me
this day of 20�by
k
o 1 1
Name of�n making st tement
Personally Known OR Produced Identification
Type of Idntification,'!�
Produceifliki U�4MM3J3 ? �y f1l
Commission No.
"' 'CASEY D FRENCH
Not P44 lic - State of Florida
My66) Expires Dec 1, 2017
Commission # FF 069924
Bonded Through National Notary Assn
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Rev. 8/2/17