HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: l Permit Number: <-'7__1�
SCANNEM
•NOW DIVED
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`Buildin.g Permit Application MAY 0 8. 2018
Planning and Development Services P®rmittin
Building and Code Regulation Division@Bent
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: Roof
PROPOSED IMPROVEMENT LOCATION:
Address:
Legal Description:
Property Tax ID #: 34-D Z — t co to — O I Li- 4 — Ccc— - Lot No.[K— 19 —
Site Plan Name: N/A Block No. 25
Proiect Name: N/A
Setbacks Front N/A Back: N/A Right Side: N/A Left Side: N/A
DETAILED DESCRIPTION OF WORK: gg
W e W i 11 4 2a.� Ok* � k4, e.x k 5�� S tN(v\ ),I_ ova `k_0 r ClN O\ O W V\
lh 5+a-At" AS ' 5A LhoRx tc�yV �' S-V v�nx*o� r0a � 3ySte wk ,
. R_1 __ __►i 1 r S_1 1 I !_
CONSTRUCTION INFORMATION:
itiona wor to e nej orme under this permit — check a apply:
E1HVAC t _J Gas Tank Ej Gas Piping _ Shutters E]Windows/Doors V!,
Electric 0 Plumbing Sprinklers Generator Roof %2 Roof pitch
Total Sq. Ft of Construction:: ,)S M&,14 I-} tla+ S . Ft. of First Floor: N/A
Cost of Construction: $ 1 ( _ Utilities: 0 Sewer E]Septic Building Height: N/A
OWNER/LESSEE:
CONTRACTOR:
Name C-
Name: Christopher Collins
Company: Collins Roofing Inc.
Address:
City: el State: L-b
Address: P.O. Box 12867
Zip Code: Fax: N/A
City: Ft. Pierce State: FL
Phone No. N/A
Zip Code: 34979 Fax: 772-489-6505
Phone No. 772-201-1352
E-Mail: N/A
Fill in fee simple Title Holder on next page ( if different
E-Mail: collinsroofinginc@gmail.com
State or County License: CCC-058011
from the Owner listed above)
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
1
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
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: _Not Applicable
Name:
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.
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 Amendments.
The followin ing p it applications are exempt from undergoing a full concur cy revi tions,
accesso ructures, swim i ols, fences, walls, signs, screen rooms and ac ssory us o nother non -re idential use
WA it TO OW : Your failure to ecord a Notice of Comm ceme �a It in your pay ng twice for
im rovements ropertyinnd
ice of Commenceme must e r r and ed on the jobsite
fore the fir ti n. If to obtain financin cons t I att ney before
ommenci r c otice of Commen ment
L
r o er a ontractor as Agent for Owner Signature ontractor/License Holder
STATE OF FLORIDA r �a STATE OF FLORIDA COUNTY OF Q � COUNTY OF '_(?�� L
The fo oing instrume t was acknowledged efore me
this day of 20by
Name of person ing statement
Personally Known OR Produced Identification
Type of Identification
16
Produced
(Sign ur of ary ? I ((ft ryT'u6fIcYfRENCH
Slate of Florida
Commi on qp GG 167258
Com Sion N R + y Commt49& Dec 11, 2021
Bonded through National Notary Assn.
REVIEWS I FRONT I ZONING
COUNTER REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17
The fo oing instrument was acknowledged before me
this day of 2by
Name o person raking statement
Personally Known VV OR Produced Identification
Type of Identification
Produced
044,
(Sig to o Public- State of Florida
lY;+ CA$€YFRENCH
Commission N ;�; NotA41t;-State of Floe'
Commission # GG 167266
+ o s My Comm. Expires Dec 11, 2021
anndM 1hrmnh National Notary Assn.
SUPERVISREVIIEWOR I RNS EV EW I VEGETATIEVI WON I SEATURTEV EWLE I M EVI WVE