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HomeMy WebLinkAboutAPPLICATION FOR ROOF PERMITr � tc ' DATE: FEES DUE. 1. Location/Site Address: 2. Parcel ID Number: 1211 M) _ ' RECEIPT #: n 7 —7o-- Permit #: Planning & Z evelopment Services Department ling & Code Regulation Division 2300 Virginia Avenue Ft. Pierce, FL 34982-5652 Tel. 772-462-1553 .TION FOR ROOF PERMIT %E REVERSE 510E FOR INSTRUCTIONS n Do 1-71 GGANNED gy St Lucia County C --TVA / Office Use ownship I Range Map Page Zoning Land Use I In' 'als Only 3. Description of Project or Work Activity: r%ck r P- - 4. Total Roof Area (square feet): 5/0 Q 1 5. Roof Pitch: 6. Type of Roof- [ ] Fiberglass Shingle [ ] Concrete Roof Tile [ ] Tar & Gravel [ ] Modified Bitumen [ ] Wood Shake / Shingle [Other W C7—nZ-- [ ] Product Approval required for alltypes of Roofing Material (2 Sets) [ ] All Commercial Roofing requires design by an Engineer or Architect (2 Sets) with Product Approval attached ** Roof Mitigation per F.S. 553.844 will be required. 7. Owner Information 8. Contractor Information Name: FL Reg/Cert #: C-CC, 05 S o ,';)- Address: 8115 Z?Il/ County Cert #: City: 4YLr Y0l State: L Business Name: e l to 'Me i Zip: 3 S/ Phone: Cell Phone: '77 a. - 4-13 - 6 CE1 9. Value of Construction: $ /Y 9®0 . ~ "Note Dry4n and Final Inspection Required. Additional inspection may be required per Product Approval. CONTRACTOR/OWNER'S AFFIDAVIT: I certify that all'of the information contained in this application is correct and that all work will be done in compliance with all applicable laws regulating construction and zoning. Z-C ar�l 11�p�.�icta- PRINT QUALIFIERS/OWNERS NAME NATURE OF QUALIFIER/OWNER STATE OF FLORiDA, COUNTY OF S� - LIA-U C— ACKNOWLEDGED BEFORE ME THIS '264'DAY OF 20 Za , BY kl Ci'vx—,G1 M a+ �I 4 4GN* IS PERSON LMYVT) MEOR HAS PRODUCED AS IDENTIFICATION Ry f Ja ,cy L, Hamilton OF NOTARY TYPE OR P NT NAME OF NOTARY (seal) '?� c; ECG;'?„Iss ON 4 EE035845 � f' RX ,RES:.GCT 19, 2014 COMMISSION NUMBER E©^7 .5iS- �'�a iia``' N ,'"'4-AARONNOTARY.com NOTICE TO OWNER: FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT YOUR LENDER OR ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. Revised 4/26/2alo