HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONj
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: L I PermitNumber: an
12 GANIVED . W "..f
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Commercial Res
R E C �_J_V ff -D
APR 2 4 2018
eermitting
I PERMIT APPLICATION FOR: Roof 1, 1
PROPOSED IMPROVEMENT LOCATION:
Address: 5q03 D�' .1 -Fr)r+ Pkips-c-e-
Legal Description: � nob ac) r i ve _r� 'e_,:�-Vcx4_cS - yAn V�- c--,cl Ln-�- 27-
i
Property Tax ID #: I() C)C-)O—
Site Plan Name: N/A
Project Name: N/A
Setbacks Front- NIA Back: N/A
Right Side: N/A Left Side: N/A
Lot'No. -Z2-
Block No. �Kl
I DETAILED DESCRIPTION OF WORK: : I
I �
no-ki cockle-,
5_\J ffv'+��j f-ccrplv-
'5
CONSTRUCTION INFORMATION -
Additional work to be nertormed under this permit — check all tbU apply:
11HVAC E]Gas Tank EJ(3as' I Piping LJ Shutters E]Windows/Do
11 Electric El Plumbing []Sprinklers 0 Generator R] Roof Roof pitch
Total Sq. Ftof Construction: ZL400 /2-4 Sq. Ft. of First Floor: N/A
Cost of Construction:$ Utilities: 0 Sewer 0 Septic Building Height: N/A
OWNERAESSEE:
CONTRACTOR:
NameMMXaS
E 0.�r hi I T) i
Name: Christopher Collins,
Address: 59n_� ck],'5(XM L)'c I
Company: Collins Roofing Inc.
City: E± , U'P Stat e:
Address: P.O. Box 12867
City: Ft. Pierce State: FL
Zip Code: :34972- Fax. N/A I
Phone No. �/A
Zip Code: 34979 Fax: 772-489-6505
E-Mail: N/A
Phone No. 772-201-1352
Fill in fee simple Title Holder on next page ( if differerit
E-Mail: collinsroofinginc@gmail.com
State or County License: CCC-058011
from the Owner listed above)
If value of construction is $200 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
Name:
Wr Not Applicable
MORTGAGE COMPANY: **'r Not Applicable
Name:
Address:
Address:
City:
Zip: Phone
Statb:
City: R. Pierce State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
VNot Applicable
BONDING COMPANY: !rNot Applicable
Name:
Address: P.O. BOX 12867
Address:
City:
City:
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Applicatio,n 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 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 Ing pe mi -appli ns are exempt from undergoing a full concurr y review: a ditions,
accesso u ures, mingpools, nces, walls) signs, screen rooms and ac sory uses t ot er non-residenti I use
WA ING T R: Your f "lu e to Record a Notice of Corn cement resulti yourpaying ice for
i roveme our pr Y. Notice of commencerne must be c a osted on ejobsite
.defore ' I le rS spect" . If y intend to obtain financi g, consult er an a e efore
cc ro" recordi vour Notice of Comme ement.
riglh4u re o%�neF/ Lessee/contractor as Agent for Owner
STATE OF FLORIDA
COLINTYOF_ S f 4-1 c-,,r e-
The forgoing instr ment was acknowledged before' me
this K2 4 A
1 day of 20_W by
av, I r ;1? S i
Name of 'person �Ong statement
Personally Known L,," OR Produced Identification
Type of Identification
Produced
ignatureQf ry 1�ublic- State of Florida
Commissi6n CAJHY J ROBIAW)
Notary Public - State of Florida
FF 221708
Commission #
Holder
STATE OF FLORIQA r
COUNTYOF .�-T-_
The forgoing instr_tAnent was acknowledged before me
this _2_�( day of 20Lk by.
Name of �erson,�ng statement
Persi un t �'� r)R Produced identification
Type of Identification
Produced
(Signature oMo—tar'y Public --State d"�Florida
Com ssJ0"#,TI1 CATHY J ROBERTS (Sea'
orl
11'< Mee I —,,
Notary Public - State of Fl r da
Commission # FF 221708
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DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17