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ALL APPLICABL INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: � • � Permit Number:
Building Permit Application
Planning and Development Services MAR It 2018
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 /
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential V
I PERMIT APPLICATION FOR: Roof
I PROPOSED IMPROVEMENT LOCATION: I
Address:
Legal Description:
Property Tax ID #: z
Site Plan Name: N/A
Project Name: N/A
Setbacks Front N/A
13 35 39 S 150 FT OF N 300 FT OF N 12 OF SW 1/4 OF NE 1/4 LYG
WLY OF I-95 R/W-LESS W 25 FT AND LESS W 185.13 FT OF N 120
FT- (0.89 AC) (OR 590-811: 1361-1588: 1764-1637 :1848-108; 3005-
917)---- - --- -
- - Lot No.
Block No.
Back: N/A Right i Side: N/A Left Side: N/A
DETAILED DESCRIPTION OF WORK: i
Wt. WkU1 �Zwv 04 ft,,� eX%sAlnc� 'r \Y)q win 4vJ
( ex_xc_ a-ra t\w< �e-raoF vv r 5 v yv,.es{-�
CONSTRUCTION INFORMATION:
Additional work to be nerformed under this permit _ c ec a apply:
0HVAC LI Gas Tank ❑Gas Piping _ Shutters a Windows/Doors
Electric E] Plumbing Sprinklers E] Generator Roof Roof pitch
Total Sq. Ft of Construction: i' LWAA ah LV S . Ft. of First Floor: N/A
Cost of Construction: $ I Zl 5. n� Utilities: Sewer O Septic
Building Height: N/A
OWNER/LESSEE:
CONTRACTOR:
Name Y
Name: Christopher Collins
Address: IL-4(Q coPc,� 1/CJ( Ka
Company: Collins Roofing Inc.
City:VL. PIML State: E(,
Zip Code: U, 5 Fax: N/A
Phone No. N/A
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
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
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
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State: I
Zip: Phone
1
City: R. Pierce State:
Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ Not Applicable
Name:
BONDING COMPANY: _Not Applicable
Name:
Address: P.O. Box 12867
Address:
City:
City:
Zip: Phone:
I
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no representation that is granting
which is in conflict with any applicable Home Owners Assc
structure. Please consult with your Home Owners Associa
In consideration of the granting of this requested permit,
in accordance with the approved plans, the Florida Buildir
The following buildi g per applications are exempt fro
accessory str etu�es, swimmi g p , ences, Ils, signs
WAR G TO OWN • our failure to Re ord a N
imp vements to r roperty. A of Cor
b ore the firs ' e io . If y I n to obtai
nmmanran r -I . e v ur otice of C
I permit will authorize the permit holder to build the subject structure
-cation rules, bylaws or and covenants that may restrict or prohibit such
ion and review your deed for any restrictions which may apply.
do hereby agree that I will, in all respects, perform the work
Y. Codes and St. Lucie County Amendments.
i undergoing a full concur cy review: m additions,
screen rooms and ac ssory uses t no er non-residen ial use
)tice of Comm cement m result' your paying ice for
imenceme must be r cord d posted on t e jobsite
i financi , consult th�I or an orney efore
)mme ement.
�-ontractor-as-Agentfor'Owner
r
�ess
I
g a - or/Li
STATE OF FLORIDA i
STATE OY FLORIDA
COUNTY OF 1�,� 8Ae
!
COUNTOF
The forgoing instrument was acknowledged before me
The for oing instrument was acknowledged before me
this day of�/�/1 20JI by
!
this day of ft4' 20 by
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%-� •i.
pip D p
0,hV-f"A0L9hj-r A .( ' - A
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Name of erso akin statement
p �OR
Name•o person aking statement
_nOR Produced Identification
Personally Known Produced.ldentification !
Personally Known
Type of Identification
Type of Identification
Produced
Produced
Si not of Notary P li z te, of Flori �Y FRENCH
( g Y F•���
(Signat of o ry Pub' - "` r' ',V fl6 u bllc - State of Florida
,
-. Notary Public - State of Florida
+ *
• s Commission # GG 167258
Commission No Corr(iGle*#GG167258
Commission No. �; My Co( iresDec11,2021
r My Comm. Expires Dec 11, 2021
'••fir
" Bonded through National NolaryAssn.
IN
Mond*d through National Notary Assn.
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Rev. 8/2/17