HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: O C�Permit Number:
e� BY
st Lucie cou"t '
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
RECEIVED
MAY 1 1 2018
ST. Lucie County, Pormitting
Residential
PERMIT APPLICATION FOR: Roof
PROPOSED IMPROVEMENT LOCATION:
Address:5MU 3 �_c- -1
Legal Description: ( n� I rain tg ja K ��-1 C� � T � — �� 1� �T ^ 0Z
Property Tax ID #:
Site Plan Name: N/A
Project Name: N/A
Setbacks Front N/A Back: N/A
Right Side: N/A I Left Side: N/A
Lot No.
Block No. I
DETAILED DESCRIPTION OF WORK:
V\)c� w \ 11-�r:��-;:C ��!Q �.v2x�C(v�,� .,ti, _I/�.\ k�'
004 . � row -'M c�..� \off' :5 A
w+ylv(t 5 -V inn irlJaF� w�,
CONSTRUCTION INFORMATION:
Additional work to be pertormed under this permit —,heck a[n, ply:
E1HVAC Gas Tank ❑Gas Piping _ S�utters Windows/Doors
11 Electric ❑ Plumbing Sprinklers 0 Generator Roof IZ Roof pitch
Total Sq. Ft of Construction: FF S . Ft. of First Floor: N/A
Cost of Construction: $ 1 L �� �IJIJ Utilities. —Se ;r 11 Septic Building Height: N/A
I
OWNER/LESSEE:
CONTRACTOR:...
Name
Address: r
City:��\Q 9" Stater(_
Zip Code: 3�° Fax: N/A
Phone No. N/A
Name:
Company:
Address:
City: Ft.
Zip Code:
Phone Nc
E-Mail:
State or
Christopher Collins
Collins Roofing Inc.
P.O. Box 12867
fierce State: FL
34979 Fax: 772-489-6505
772-201-1352
E-Mail: N/A
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
gollinsroofinginc@gmaii.com
County License: CCC-058011
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: Ft. Pierce State:
Zip: Phone:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: _Not Applicable
Name:
Address:
Address: P.O. Box 12867
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 spec
in accordance with the roved plans, the Florida Building Codes and St. Lucie Co Amendme
The following ding permi a ' ations are exe pt from undergoing a ful oncurrency review:
accessory s uctures, swim ng pools, fences, wall , signs, screen rooms d accessory uses to art
WAR NG TO O Your failu o Rec rd a Notice7nce
mencement maVn�
movements Noti of Comment mustbe recb ore the fi s t . I ou inte toobtain fInconsultwin
ommenci a si+r R vo Notice of Comment. /'
the work
additions, \
non-residential use
STATE OF FLORIDA Q p STATE OF FLORIDA��� p��
COUNTY OF (� (�� � COUNTY OF mLU_(6i f_—
The forgoing instrument was acknowledged before me
this I I day of 2017 by
1 00 Is
Name of person making statement
Personally Known ✓ OR Produced Identification
Type of Identification
CASEY FRENCH
NotarMljll� - State of Florida
Commission # GG 167258
My Comm. Expires Dec 11, 2021
Bonded through National Notary Assn.
The forgoing instrument was acknowledged. before me
thisjLdayof MQ," : 0 J by
Name of Orsonlnaking statement
Personally Known rr OR Produced Identification
Type of Identification
ota ublic- State of Florida
�};y;•., C,ASEYFRENCH
No '� Notary ( MidyState of Florida
• ; " • Commission # GG 167258
' ,o c My Comm. Expires Dec 11, 2021
n•''���� '•• RnndM thmunh National Notary Assn.
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Rev. 8/2/17