HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ��— SCANNED Permit Number: Q I
LRIVBuilding Permit Application 0 2018Planning and Development Services
Building and Code Regulation Division ty, Permitting
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential X
PERMIT APPLICATION FOR: Roof
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Address: 10725 S Ocean Dr #419 Jensen Beach j
Legal Description: Holiday Out at St. Lucie - Sec B BLK Q Lot 28 and equal pro-rata interest in
Common elements (OR 3670-994)
Property Tax ID #: 4511-502-0145-000-0 I Lot No. 28
Site Plan Name: Block No. Q
Project Name: Osborn Residence
Setbacks Front Back: Right Side: Left Side:
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Remove existing shingle roof and replace with new metal roof
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AdditionalworK to be perrormed under this permit — c Or all apply:
aHVAC L_J Gas Tank ❑Gas Piping _ Shutters a Windows/Doors
Electric F� Plumbing Sprinklers Generator 0— Roof Roof pitch
Total Sq. Ft of Construction: 799 S . Ft- of First Floor: 799
Cost of Construction: $ 5300 Utilities: 0Sewer Septic Building Height: 8'
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Name Ronald & Marsha Osborn Name: Jamie Cisco
Address: 1940 Bamby Lane Company: Sunshine Roofing LLC
City: Milford State: Ml Address: PO Box 1083
Zip Code: 48381 Fax: City: Palm City State: FL
Phone No. 248-444-7993 Zip Code: 34991 Fax:
E-Mail: mloveoz@comcast.com Phone No. 772-260-8195
Fill in fee simple Title Holder on next page (if -different E-Mail: sunshineroofingllc@gmail.com
from .the Owner listed above) State or County License: CCC1327796
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER:
_ Not Applicable
MORTGAGE COMPANY: —
Not Applicable
Name:
Name:
Address:
Address:
City:
State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
_ Not Applicable
BONDING COMPANY: _Not
Applicable
Name:
Name:
Address:
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.
I 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 Owner's 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 Amendments.
The following building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, walls,1 signs, screen rooms and accessory uses to another non-residential use
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 jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
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Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF St. Lucie
COUNTY OF St. Lucie
The forgoing instrument was acknowledged before me
thisaDay of I 'no Y'C26LY by
The forgoing instrument was acknowledged before me
this _, day of . 20_ by
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(066c r)
Jamie Cisco
Name of person making statement
Name of person making statement
Personally Known OR Produced Identification '�
Personally Known X OR Produced Identification
Type of Identification
Type of Identification
Produced I'. Cerise
Produced
WSigntureN
(Signatu of Notary c- a o i a
otary P blic State of Floridao
to O t t ri a
a Notary Public S ate of Florida
? o Maril�egel
Commission No. Q �y C i sion FF 230179
�, Marilyn Klu��^el^1 e
Commission No. 4 CommissWtt�P130179
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Expires 06l2812019
Expires 06/28/2019
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17