HomeMy WebLinkAboutBUILDING PERMIT APPLICATION1 S
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: `'�• ,t"g' �SCANNED Permit Number: I
;REEIVED
• �$ tQ�P.IP �°P911n
Building Permit Application 2 8 2018
Planning and Development Services �ST' Wnty, Permitting
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578' Commercial Residential
PERMIT APPLICATION FOR: Roof
PROPOSED IMPROVEMENT LOCATION:
Address:
Legal Description: Q '�/�{ �Cb[�� - 1�X1171� (0
Property Tax ID #: 13() I - LODlo _ d(314-V- (ow- LD Lot No. 9 +10
Site Plan Name: N/A Block No. r_)z
Project Name: N/A
Setbacks Front N/A Back: N/A Right Side: N/A Left Side: N/A
I DETAILED DESCRIPTION OF WORK: I
Wc. wt11 +ewr p extsjk_'�51nk \.L avd dowv\ r�c,�
a ut rwal 0� +0 it,"W Code. o� msj-o1 l a r\e-w 5 -/ m eA-c
roof out a- 5.&F 6&&A Kee. V` 1P t+ v wv'^ 0Y\
CONSTRUCTION INFORMATION:
Additional work to e nertormed under this permit — c ec ,a apply:
11HVAC Gas Tank Gas Piping Shutters Q Windows/Doors
aElectric 0 Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: 0.0 Z# PlOd— S . Ft. of First Floor: N/A
Cost of Construction: $ Utilities:cn Sewer E]Septic Building Height: N/A
OWNER/LESSEE:
CONTRACTOR:
Name
Name: Christopher Collins
Address:
Company: Collins Roofing Inc.
Address: P.O. Box 12867
City: FIR -e-y-cy— State: q
Zip Code: 34951 Fax: N/A
Phone No. N/A
City: Ft. Pierce State: FL
Zip Code: 34979 Fax: 772-489-6505
Phone No. 772-201-1352
E-Mail: collinsroofingincQa gmail.com
State or County License: CCC-058011
E-Mail: N/A
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
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:
City: Ft. Pierce State:
Zip: Phone:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address: P.O. Box 12867
BONDING COMPANY: _Not Applicable
Name:
Address:
City:
City:
Zip: Phone:
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 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 n I I IIIE. ts.
The following bull g permit a lic ar empt from undergoing a full co rrency revi oom additions,
accessory str ures, swimmin ools, fences,iw Ils, signs, screen rooms an ccessory us o a other non -reside tial use
WARN G TO OWN ur failure t ord a Notice of Com encement It in yo yin twice for
impr ements to operty. a of Commencem t must b r or d o ed o the jobsite
be re the first' p n. If u " e to obtain financi g, consul ith r attorn before
c mencine o red in otice of Comment ement. /
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA�'� l// f
STATE OF FLORIDA Q
COUNTY OF OJiT— l.(.zll
COUNTY OF .c C:t
The forgoing instrument was acknowledged before me
The forgoing instrument was ac <nowledged before me
by
this " day of -f7)dA C�t . 201& by
this oZ day of 26jJ
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�V VLd, �' lJ��l l.tilixt�lt�o
�
Name of personlnaking statement
Name of person king statement
Personally Known N., OR Produced Identification
Personally Knon OR Produced Identification
w
Type of Identification
Type of Identification
Produced
Produced
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(Signat e f o a
CASEYFRENCH
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(Signatur o to -,,, ,
rr�.; C S FRENCH
"� o : Notary Pu St to of Florida
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Commission No. �' Notary(90b)-Stale of Florida
Commission No. • •'• Commis 0 G 167258
• . + • Commission # GG 167258
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:,�• --My Comm. Expires Dec 11, 2021
'�` ��� Bonded through National Notary Assn.
uEhNlaenDNotaryAOsn1
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Rev. 8/2/17