HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Permit Number: l l 1- Oq /b
Date:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 ` 'r
Phone: (772) 462-1553 Fax: (772) 462-1578 Comrilercial Residential °�—
PERMIT APPLICATION FOR: Roof
c E,
PROPOSED IMPROVEMENT LOCATION:
Address: 5104 La Salle st Fort Pierce FI 34951
Legal Description: LAKEWOOD PARK UNIT 12-A BLK 173-A LOT 3(MAP13/13N)(OR 3333-1434)
Property Tax ID #: 1301-615-0127-000-1
Site Plan Name: N/A
Project Name: N/A
Setbacks Front N/A Back: N/A
DETAILED DESCRIPTION OF WORK:
Right Side: N/A - Left Side: N/A
Remove exiting roof shingle and torch down on flat roof
Install peel & stick Underlayment + Owen corning shingle
Install modified peel & stick in flat roof
Lot No.3
Block No. 173
CONSTRUCTION INFORMATION:
Additional work to e e orme under this permit — check a apply:
OHVAC ID Gas Tank OGas Piping _ Shutters Q Windows/Doors
0 Electric 0 Plumbing Sprinklers 0 Generator Roof 2 Roof pitch
Total Sq. Ft of Construction: 2400
Cost of Construction: $
S Ft. of First Floor: 2400
UtilitiesliSewer OSeptic Building Height.:
OWNER/LESSEE:
CONTRACTOR:
Name Gwendolyn Stronman
Name: Mauricio Orellana
Address:5104 La Salle st
Company: One Construction & Roofing contractors
City. Port saint Lucie State: FI
Address: 2766 sw Edgarce st
City: Port Saint Lucie State: I`l
Zip Code: 34953 Fax: N/A
Phone No.305-309-0171
Zip Code: 34953 Fax: N/A
E-Mail:N/A
Phone No. 772-240-9497
Fill in fee simple Title Holder on next page ( if different
E-Mail: oneconstructionservices@yahoo.com
from the Owner listed above)
State or County License: CCC-1330623
If value of construction is 52500 or more, a KI:cUKutD Notice oT commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Ap able
MORTGAGE COMPANY: _ Not Applicable
Name: Gwendolyn Stronman
Name : Mauriclo Orellana
Address: 5104 La Salle st Fort Pierce FI 34951
Address: 5104 La Salle st
City: PortSalntLucie State:
City: PortsaintLucie State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITL LDER: _ Not Applicable
BONDING COMP Not Applicable
Name:
Name:
Address:
Address:27 wEdgamest
city:
city:
Z' 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/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF 5E� . c:r COUNTY OF S \ .
Thefor iinng instrument was acknowledged before me
t(hiiss,-3dday of 20_1-D y
Name of person making statement
Personally Known _�t3R Produced Identification
Type of Identification
Produced
The forgoing instrument was acknowledged before me
this -�4 day of Nri 14 t = h\16CL 20_)4- by
Name of person making statement
Personally Known Produced Identification
Type of Identification
Produced
(Signature xf Notary Public -State of F orid Si a r c
Commissio N s ..a%� PAULETTE BL lFt66 P1a
Notary Public State of Florida
°� ` " Commission i FF 995699
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:�__.,op. My Cnmm_ Exo res San 6. 2020
'Al
Public-'
Wo`t'dry Public - State of I
Commission # FF 995
My Comm. Exolres Seo 6
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REVIEWS
FRONT
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VEGETATION
SEA TURTLE
MANGROVE
S P SO
PLANS
COUNTER
REVIEW
REVIEW
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REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17