HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ) '^� �7
Date: �• �' J Permit Number: / � V D b ,7
ANNE-D
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Lucie COUniv
Building Permit Application ED
MAY 0 2018
Planning and Development Services
Building `and Code a e Regulation Divisions' • Pe rm l ttl i1 rtm e n t
2300 Virginia Avenue, Fort Pierce FL 34982 g p
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial si�"iittaUCl ty, FL
PERMIT APPLICATION FOR: Roof
PROPOSED IMPROVEMENT LOCATION:
Address: 4913 Mqdlc FbriJ e EL
Legal Description: iY1rfi (') n R1y.t!.Ir c -s4e,, e S \� nr- o-'I F311- 42- I—ut 2,
Property Tax ID #: -3402 — Cv08- ()1 4-57000-3 Lot No. Z1
Site Plan Name: N/A Block No. 42—
Project Name: N/A
Setbacks Front N/A Back: N/A Right Side: N/A Leff Side: N/A
I DETAILED DESCRIPTION OF WORK: I
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CONSTRUCTION INFORMATION:
Additional work to e "ertormecl under this permit —check all that apply:
11HVAC Gas Tank ❑Gas Piping _ Shutters Q Windows/Doors
ElElectric 0 Plumbing 1-1:Sprinklers ElGenerator R] Roof �z Roof pitch
Total Sq. Ft of Construction: 3200 S . Ft. of First Floor: N/A
Cost of Construction: $ R9,(ffi.M Utilities. Sewer Septic Building Height: N/A
OWNER/LESSEE:
CONTRACTOR:
Name H i(_Vicud ` Re_rtki B4,- ey—
Name: Christopher Collins
Company: Collins Roofing Inc.
Address: P.O. Box 12867
City: Ft. Pierce State. FL
Zip Code: 34979 Fax: 772-489-6505
Phone No. 772-201-1352
Address::4q1, 4v1 Ur-i2Apr
R City: , r1 e trCe- 'State: FL
Zip Code: �7 10Z Fax: N/A
Phone No. N/A
E-Mail: N/A
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail: collinsroofinginc@gmail.com
State or County License: CCC-058011
If value of construction is 52500 or more, a RECORDED Notice of Commencement is required.
,,SU,PPLEMENTAL CONSTRUCTION LI'EN LAW I-NFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: Ft. Pierce State: _
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: 04r_Not Applicable
Name:
Address:
City:
Address: P.O. Box 12867
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 approved plans, the Florida Building Codes and St. Lucie County AJn ents.
The followin i ding pe"qnit a a ions re exempt from undergoing a full co rrency review: oom additions,
accesso ructures, swi ing pools, fenc s, walls, signs, screen rooms an ccessory uses to er non -re ' ential use
W ING TOO VYo:urre Record a Notice ofCo encement m r ult n your pa in twice for
i provements yA otice of Commence nt must be r rd d n hejobsit
efore the spntend to obtain finan ng,consult I o att a before
e our Notice of Comm cement.
�i - 1z4
ure wn ee/Contractor as Agent for Owner sTignatb o tra or/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF S-� Z_'J c,'-e— COUNTY OF S4- 'Q
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of VY1c,,. 20JZ—by
Name of erson making statement
Personally Known _Lef"'OR Produced Identification
Type of Identification
Produced
this _-2 day of /M �. , 20fL— by
s
Name o person aking statement
Personally Known &011 Produced Identification
Type of Identification
Produced
(Signatire4�ry P4�rNoayb�fd(5ignat esf�la
nlria �g%ad
Notary
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Commi N Commi 27n # FF 22My Comm. Expires May iC, 2019 %�,r a;; My Comm. Expires May iC, 2019
Bonded through National Notary Assn. °'�0 +�`�� Bonded through National Notary Assn.
REVIEWS I FRONT ZONING
COUNTER REVIEW
RECEIVED
DATE
COMPLETED
Rev. 8/2/17
SUPERVISREVIEWOR I REVIEW PLANS I VEGETATIE EWON I SEATURTEV EWLE I M EVIEWVE