HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: SUAN11 W Permit Number: 110( •By
- RECEIVED
Building Permit Application JUN 19 7018
Planning and Development Services permitting Department
Building and Code Regulation Division St. Lucie county
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line '20a:
PROP-OSED` IM'PROVEMI NT LOCATION
Address: 12514 WEST MIDWAY
Legal Description: ST LUCIE COUNTY 5 36 39
Property Tax ID #: 3305-142-0000-000-2
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
TEAR OFF EXISTING ROOF, INSTALL NEW TAMKO SHINGLE AND INSTALL NEW FLAT ROOF
Lot No.
31':1a"M
CONSTRUCTION INFORMATION:
Acid itional work to e e orme under this permit —check a apply:
❑HVAC 1. Gas Tank []Gas Piping fn Shutters Q Windows/Doors
❑ Electric ❑ Plumbing ❑ Sprinklers ❑ Generator Z Roof 5 1 Roof pitch
Total Sq. Ft of Construction: 1826
Cost of Construction: $ 8,000
S Ft. of First Floor: _
Utilities: Sewer ❑Septic
Building Height: A.
OW N ERAESSEE:
CONTRACTOR:
Name DAODATEE NAGAPOOLLAY
Name: h n
Address: 12514 WEST MIDWAY
Company: TREASURE COAST ROOFING
City: FORT PIERCE' State:FL
Address: 1816 SW BILTMORE STREET
Zip Code: 34,'945 Fax:
City: 9,3 L t State: FL
Phone No. GS q " 6 s - Lil 3 � 1
Zip Code: 34984 Fax: 772-343-8358
E-Mail: rJ 1 A
Phone No. 772-370-9770
Fill in fee simple Title Holder on next page (if different
E-Mail: TCROOFINGLLC@GMAIL.COM
from the Owner listed above)
State or County License: CCC1330653
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not App
Name.
Address: Y
City: State
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address: AY
City: State:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:_
Address:
City:_
Zip:
Pho
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 Amendments.
The following building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in your paying twice for
improvements to your property. A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording your Notice of Commencement.
,/, �—�ro�
—7.7-1:1
Signature of Con ractor ' ense 661der
Signature of Owner 'LesseWontiQUk as Agent for Owner
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF STLCUIE
COUNTY OF STLUCIE
The forgoing instrument was acknowledged before me
The for oing instrument was acknowledged before me
this � day of �1l ).ram_ , 20\A by
this day of.r+•C_ , 20 1?i by
BRIAN J MALONEY
BRIAN J MALONEY
Name of pers m ing statement
Name of perso aki statement
Personally Known x OR roduced Identification
Personally Known x Z Produced Identification
Type of Identifica ' n
Type of ldentificat' n
Produced
Produced
ary Public- State of Florida)
(SignatuYn
(Signature Pu lic- State of Florida )
Commiso.FF12243a ,••"'Y�� (Se BERTBRUNKE
Commissi n No. FF122434 vv�•.,, � BRUNKE
_Notary Public — State of Florida
`•Commission # GG 176972
= . .' : Notary Public — State of Florida•
•
U4.1'
+ Commission #GG 176972
`:�a
P My Comm. Expires May 12, 2022
F- My Comm. Expires May 12. 202
Bonded :rug
a ona' ovary Assn.
Bonded through
ationa' NoaryAssn.
REVIEWS
FRONT
VEGETATION
S A
PRIMN
_SFJPERVIsolT1PLANS
COUNTER
REVIEW
REVIEW
RE IEW
REVIEW
REVIEW
REVIEW
DATE
(� d
RECEIVED
d
DATE
c)
COMPLETED
rid
tev.8/2/17