HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE OMPLETED
Date: _� . I � - % i(II
Buildi
Planning and Development services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
APPLICATION TO BE ACCEPTED
3aMV' Permit Number: o&:� 7.
A%
Permit Application
Commercial Residential
MAR 16 2018
I PERMIT APPLICATION FOR: Roof I I
I PROPOSED IMPROVEMENT LOCATION: ! 1
Address:
Legal Description:
Property Tax ID #: n�t I !I - nj �
Site Plan Name: N/A
Project Name: N/A
Setbacks Front N/A Back: N/A
i� Lot No.
Block No. LP
Side: N/A Left Side: N/A
DETAILED DESCRIPTION OF WORK:
_VAk, 1�\Noo Grand, Ye, nakk Coc��, rooF v�►� Rs l�
CONSTRUCTION INFORMATION: i
Additional work to e e orme under t is permilt — check a apply:
EIHVAC E] Gas Tank Gas Piping _ Shutters Q Windows/Doors
FlElectric 0 Plumbing OSprin I lers Generator Roof Roof pitch
Total Sq. Ft of Construction: 2 (00 S . Ft. of First Floor: N/A
Cost of Construction: $ ¢ 21) • Utilities. Sewer Septic Building Height: N/A
OWNER/LESSEE:
CONTRACTOR:
Name I
Address: `(rj�` N-VhIM a I
City: Stater
Zip Code:17)4q5ZFax: N/A I
Phone No. N/A I
Name: Christopher Collins
Company: Collins Roofing Inc.
Address: P.O. Box 12867
City: Ft. Pierce State: FL
Zip Code: 34979 Fax: 772-489-6505
Phone No. 772-201-1352
E-Mail: collinsroofinginc@gmail.com
E-Mail: N/A I
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above) I
State or County License: CCC-058011
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: L Name:
Address: O S Address:
City: . State: City: R. Pierce State:
Zip: Phone�—z�G�f Zip: Phone:
C
FEE SIMPLE TITLE HOLDER: r Not Applicable
Name:
Address: P.O. Box 12867
City:
Zip: Phone:
BONDING COMPANY:
Name:
Address:
Citv:
Zip: Phone:
Applicable
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
1 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 th pro d plans lorida Building Codes and St. Lucie County Amendments.
The following wilding per pplications are a empt from undergoing a full concurre review: ro`
accessory ructures, s m' g pools, fences, w Its, signs, screen rooms and acc ory uses to a raon-reside tial use
WA ING TO 0 N . Your failure R cord a Notice of Comm cement ma suit' your paying ice for
Ferifore
rovements o,, r property No ce of Qommenceme must be re rded nd poste on t e jobsite
the fir 's ection. If u f t d to obtain financi g, consult " lend n me efore
mela> tit o or reco n>/o Notice of Comme ement,�
STATE OF FLORIDA ��► j
COUNTY OF 7"U1i,
The for oing instrument was acknowledgg before
this jz day of rMA . 20 I by
Name f perso making statement
Personally Known OR Produced Identifical
Type of Identification
Produced
Commission
3NdTbWRRia - State of Florida
Comrnisslon # GG 167�58
My Comr(SPOI)es Dec 1 , 2021
Bnndrxl through National NolaryAssn.
STATE OF FLORIDA 01
II --
COUNTY OF `X
The f r oing instru nt was acknowledge before me
this JAA 20 by
Name & perso making statement
Personally Known OR Produced Identification
Type of Identification
Produced
(Signatu
Commission No.
'rotaryry Pdblic - Stale of Florida
Com Issio # GG 167258
My Cor@hres Dec 11, 2021
Bonded through National Notary Assn.
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17
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