HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED r^ (�
Date: 6'A%1_ Permit Number: /ab , o 1 -/
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Building Permit Application JUN 2 8 2017
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 X
PERMIT APPLICATION FOR: Roof
PROPOSED -IMPROVEMENT LOCATION:
Address: 339 MIDWAY RD
Legal Description: PALM GARDENS SID IN SEC 33040E75FrOFW1005FT OF LOT GLYG N OF SLIOFN Vt OF BL% I OF REPLAT OF PALM GARDENSANDS OF SRANAODWAYRDAKAE10FT OF=4.
ALL LOT 5 AND W 25 FT OF LOT6 BLK 1 COLLINS PARK AS IN PB 5-37 (0.25 AC) (OR 3477-1125, 1127; 3484-508)
Property Tax ID #: nJf7 �i' g6� " QGOD - (300 —�1 Lot No.5,6
Site Plan Name: Block No. 1
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Remove existing roof covering and install 26 Ga. 5V crimp metal roof covering
Pitch 021)a T 4
11HVAC UGasTank
11 Electric 1:1 Plumbing
Total Sq. Ft of Construction: 1,420
Cost of Construction: $ 8190.00
r this permit — cnecK au apply:
❑Gas Piping _ Shutters Q Windows/Doors
Sprinklers Generator Roof
S Ft. of First Floor:
Utilities: Sewer OSeptic Building Height:
OWNER/LESSEE:
CONTRACTOR:
NameSavanna Concierge LLC
Name: Larry Neese
Address:1239 Alton RD
Company: Larry Neese Roofing, LLC
City: Miami Beach State: F�
Zip Code: 33139-3826 Fax:
Phone No.
E-Mail:
Address: 488 S. Market Ave.
city: Fort Pierce State: FL
Zip Code: 34982 Fax: 772-361-6581
Phone No. 772-361-6580
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail: larry(c LNroof.com
State or County License: FL CCC1330608
If value of construction is $2500 or more, a RECORDED Notice of Commencement is requires.
i
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION
Designer/Architect/Engineer:
Name
Mailing Address
City
zip Phone
❑ Not Applicable I Mortgage Company: ❑ Not Applicable
Name
Mailing Address
State City
zip Phone
Fee Simple Title Holder's Name: ❑ Not Applicable
Name
Mailing Address
Citv State
zip Phone
Bonding Company:
Name
Mailing Address
City .
zip Phone
State
❑ Not Applicable
State
Notice to Owner: There are some properties that may have deed restrictions recorded upon them. These
restrictions may limit or prohibit the work applied for in your building permit. It may be to your
advantage to check and see if your property is encumbered by any restrictions.
Owner/Contractor Affidavit: Application is hereby made to obtain a permit to do the work and installations as
indicated. I certify that no work or installation has commenced prior to the issuance of a permit.
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 2010 Florida Building Code and Martin County Amendments.
Plan revisions on all structures exempted by code from architectlengineer design may be done by permit holder.
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 job site before
the first inspection. If you intend to obtain financing, consult with your lender or an attorney before
commencing work or recording your Notice of Commencement.
I certify that all the foregoing information ' accurate and that all work will be done in compliance with all
applicable laws regulating constructio zoning.
C�
Si tore of Owner/ gent/Lessee
STATE OF FLORIDA
COUNTY OF MARTIN
The foregoing instrument was acknowledged before me
this day of 20_ by
(Name of Person Acknowledging)
(Signature of Notary Public — State of Florida)
(Print, Type, or Stamp Commissioned Name of Notary Public)
Personally Known OR Produced Identification
Type of Identification Produced
(FBC 2010)
ignature of Con cto License Holder
STATE OF FLORIDA
COUNTY OF MARTIN
The foregoing instrument was acknowledged before me
this as day of t = n P 20 f I by
& (etj C t,Nr'tCG) Qi
(Name Person Acknowledging)
)
(Signature of Notary of Notary Public — State of Florida)
(Print, Type, or Stampommissioned Name of Notary Public)
Personally Known OR Produced Identification
Type of Identification Produced
T:\BLD\Bldg_Forms\New Applications\Applications\Building Permit Application.Docx Rev. 3/16/12
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