HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR
Date: t Dly../ 9I
J
ATION TO BE ACCEPTED
Permit Number:
Building Permit Application July 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: 337 JOHNSTON ST
Legal Description: REPLAT OF PALM GARDENS BLK 5 W 25 FT OF LOT 2 AND ALL LOT 3 (0.24AC) (OR 3721-1915 ERRONEOUS LEGAL; 3872-1768)
Property Tax ID #: 3403-802-0058-000-9
Site Plan Name:
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
Lot No.2,3
Block No. 5
Additional worK to be nertormecl under this permit— cnecK all apply:
❑HVAC Gas Tank ❑Gas Piping In Shutters ❑ Windows/Doors
❑ Electric ❑ Plumbing ❑Sprinklers ❑ Generator Roof
Total Sq. Ft of Construction: 1360 S Ft. of First Floor:
Cost of Construction: $ 8095.00 Utilities:i Sewer ❑ Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:.
NameSavanna Concierge LLC
Name: Larry Neese
Address:1239 Alton RD
Company: Larry Neese Roofing, LLC
City: Miami Beach State:FL
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
E-Mail: lany(aD-LNroof.com
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
State or County License: FL CCC1330608
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required. .
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1
['SUPPLEMENTAL CONSTRUCTIONLIEN LAW 'INFORMATION
Designer/Architect/Engineer: ❑ Not Applicable
Name
Mailing Address
City State
zip Phone
Fee Simple Title Holder's Name: ❑ Not Applicable
Name
Mailing Address
City
zip Phone
State
Mortgage Company:
Name
Mailing Address
City
zip Phone
Bonding Company:
Name
Mailing Address
City
zip Phone
❑ Not Applicable
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 architect/engineer 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 is accurate and that all work will be done in compliance with all
applicable laws regulating construction and zoning.
Signa er/Agent/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)
Si act /License Holder
STATE OF FLORIDA
COUNTY OF MARTIN
The foregoing instrument was acknowledged before me
this day of -Z�'L _ny 2011 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
T:\BLD\Bldg_yorms\New Applications\Applications\Building Permit Application.Docx Rev. 3/16/12