HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONi•
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1 1 1 { Permit Number: ��C�cI
.:,�-- SCANNED REED
`' 9 a�:y �� . �,,,,1l APR 12 NIB
BW W1'AIg OWA* Applicatio
Planning and Development Services S-r. Lucie County, 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 — *-'�q �
PROPOSED IMPROVEMENT LOCATION:
Address: � 9 �bc+ i (— t—L
Legal Description: M(_A_rC1_' \1
Property Tax ID #: 2 t,2, I — R()2 t —��(�� Lot No. 3
Site Plan Name: N/A Block No.
Project Name: N/A ' ,
Setbacks Front N/A Back: N/A Right Side: N/A Left Side: N/A
DETAILED DESCRIPTION OF WORK: -
-exks- 1n n� ire � l �O( Gw ►'�
�-O -�4"�-- 1\� �/v_0'� 1 1' ll -�o COot�. 1�-� W.i�� w)5A-alk o� 5-�'I
.CONSTRUCTION INFORMATION:
Additional work to e e orme under this permit— check a apply:
11HVAC E] Gas Tank ❑Gas Piping _Shutters Q Windows/Doors
Electric 0 Plumbing ElSprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: 115M1 1 S . Ft. of First Floor: N/A
Cost of Construction: $ < 4.2' �,L 0.e V 11 Utilities. Sewer Septic Building Height: N/A
OWNER/LESSEE: " .,
CONTRACTOR:
Name 51
Name: Christopher Collins
Address::-3 v �J O.C�5� C1
Company: Collins Roofing Inc.
City: `, I I v Q f O'Ace State: t 1
Zip Code: 4q-Z2-0- 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.
/ I
SUP' LEI' ENTAL`CQNSTRUCTION LIEN' LAW INFORIVIATtON: .. ' .
DESIGNER/ENGINEER:
Name:
_ Not Applicable
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
Address:
City: Ft. Pierce
Zip: I Phone:
State:
City: State: i
Zip: Phone I
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
Address: P.O. Box 12867
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 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 oved plans, the Florida Building Codes and St. Lucie County Amendments.
The followin uilding permit ications a exempt from undergoing a full concur y review: roo ditions,
accesso tructures, sw. mi g pools, fences walls, signs, screen rooms and a ssory uses to a er on -residential us
W NING TOO : our fail to eco�d a Notice of Com cement may in y r paying twice fo
i provemen o ur ro Y. ice of Commencem must be re rde nd osted on the jobs e
efore the st ' t' . If in nd to obtain financi g, consul le er o e efore
comme a eco ur Notice of Comme ement.
Sig ure of Owner Lessee/Contractor as Agent for Owner
Sign ontra a Holder
STATE OF FLORIDA
4 /,(j
STATE OF FLORIDA
COUNTY OF Sr e
COUNTY OF
,Lu
The forgoing instrument was acknowledge before me
The for oing instru pent wa acknowledg before me
_a
by
this �-day of 20[by
this day of I 20tr
Name of erson making statement'
Name of person making statement
Personally Known ✓ OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature of IV a State of Florida )
(Signature of No ublic- State of Florida)
Commission No. r 7pf-(Seal)
,Public-
Commission Nof V� (Seal)
"`-
�aY'n''•. CATHYJROBERTS
CATHY J ROBERTS
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`' Notary Public
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- State of Florid;
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UPERVISOR
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DATE
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-
RECEIVED
DATE
COMPLETED
Rev.8/2/17