HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 04/13/2018 1 I Permit Number:
mRECEIVE[
Building Permit Application APR 13 2018
Planning and Development Services
Building and Code Regulation Division Permitting De pa rtmE
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Resi en&l Lucie County, F
PERMIT APPLICATION FOR: Roof 1
PROPOSED IMPROVEMENT LOCATION:
Address: 5409 BUCHANAN DRIVE, FORT PIERCE, FL 34982
Legal Description: INDIAN RIVER ESTATES -UNIT 1- BLK6 LOTS 5 AND 6
Property Tax ID #: 3402-602-0197-000-8 1
Site Plan Name: 1
Project Name: WILLIS FLAT ROOF 1
Setbacks Front Back: Right Side: 1 Left Side:
1
DETAILED DESCRIPTION OF WORK:
REMOVE EXISTING FLAT ROOF AND INSTALL NEW FLAT ROOF.
1/2"/12 SLOPE
Lot No. 5 & 6
Block No. 6
CONSTRUCTION INFORMATION:
'l
AdditionaiworKtobenertormedunder this permit— checK
LHVAC Gas Tank Gas Piping
all
that apply:
f Shutters
E]Windows/Doors
Electric 0 Plumbing
Sprinklers
❑lGenerator
R1 Roof 1�2/12 Roof pitch
Total Sq. Ft of Construction: 300
S . Ft. of First Floor:
Cost of Construction: $ 2000
Utilities: 11 er O Septic
Building Height: 12'
OWNER/LESSEE:
CONTRACTOR:
NameRALPH WILLIS
Name: RldARDO LARA
Address:5409 BUCHANAN DRIVE
Company: ELITE ROOFING SOLUTIONS, INC
City: FORT. PIERCE State:FIL
Zip Code: 34982 Fax:
Phone No.772-286-0033
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Address: 812 SE LINCOLN AVE
City: STUART State:FL
Zip Code: 349P4 Fax:
Phone No. 772-643-7663
E-Mail: ERS.PERMITS@GMAIL.COM
State or County1License: CCC1330337
If value of construction is $2500 or more, a RECORDED Notice of Commencement is
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DESIGNER/ENGINEER:
Not Ap licable
MORTGAGE COMPANY:
_ Not Applicable
Name:
Name:
Address:
I
Address:
City:
State.
City:
State:
Zip: Phone
1
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
_ Not Applicable
BONDING COMPANY:
_Not Applicable
Name:
Name:
Address:
1
Address:
City:
1
City:
Zip: Phone:
Zip: Phone: 1
OWNER/ CONTRACTOR AFFIDVIT: Application is hI,reby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prioro the issuance of a permit.
St. Lucie County makes no representation that is granting allpermit 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 Amendments.
The following building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
WARNING TO OWNER: Your failure to Record a Notic of Commencement may result in your paying twice for
improvements to your property. A Notice of Comme , cement 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
rnmmPnrino wnrle nr rPrnrdino vnur Nntire of rnmmpncement_
0.0
natur o essee/Contractor as Agent for Owner
at e o rector/License Holder
STATE OF FLORIDA
;_11'n
TATE OF FLORIDA
COUNTY OF
OUNTY OF /%iQR�Jq
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
t is 73 dday APa� J 20 / P by
this day of . 20_ by
of .
Name of person making statement
Name of person making statement
Personally Known OR Produced Identification
Personally Known i�i OR Produced Identification
Type of Identification
Type of Identification
Produced
Prod ced
C
(Signature of Notary Public- State of Florida)
(Signature of Notary Public- State of Florida )
,ott'y so Theresa Anne Fasano
Commission No. (Seal)
Commissio o NOTARY PUBLIC (Seal)
STATE OF FLORIDA
Ws Comm# GG126275
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS I
VEGETATION
IFIVIZUZI
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
I
DATE
COMPLETED
Rev. 8/2/17
l9oy`- 0393. �
a
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Ap licable
MORTGAGE COMPANY: Not Applicable
Name:
_
Name:
Address: I
Address:
City: State
City: State:
Zip: Phone
I
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Appl cable
BONDING COMPANY: Not Applicable
Name:
.Name:
Address:
Address:
City:
City:
Zip: Phone: I
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application i� tIhereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced pror to the issuance of a permit.
St. Lucie County makes no representation that is grantir g 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 Build' g Codes and St. Lucie County Amendments.
The following building permit applications are exempt fr m undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, walls, sign , screen rooms and accessory uses to another non-residential use
WARNING TO OWNER: Your failure to Record a l4otice of Commencement may result in your paying twice for
improvements to your property. A Notice of Co 'mencement must be recorded and posted on the jobsite
before the first inspection. If you intend to obtai financing, consult with lender or an attorney before
commencing work or recording your Notice of C mmencement.
ctor as Agent for Own
STATE OF FLORID�„��h
COUNTY OF //����
The forgoing instrument was acknowledged before me
this /3 day of /9P•u% 20 /P-by
ZeA?4(e L"A
Name of person making statement
Personally Known �v OR Produced Identification
Type of Identification
Produced
(Signature of Notary PThe esa Anne ofFlorida
)
Commissi NOTARY PUBLIC (Seal)
STATE OF FLORIDA
Comm# GG126275
S gnat e o actor/License Holder
STATE OF FLORIDA
COUNTY OF AI R-V4n
The forgoing instrument was acknowledged before me
this /3Qday of f}P/Zi , 20 / by
�C /l��d0 Gf)7e1�
Name of pe`s'on making statement
Personally Known 14 OR Produced Identification
Type of Identification
Produced
(Signature of Notary Public- State of Florida )
111RI Theresa Anne Fasano
Commissio o NOTARY PUBLIC (Seal)
` ' STATE OF FLORIDA
'� ? Comm# GG126275
.P .o;
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS,
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
I
DATE
COMPLETED
Rev. 8/2/17