HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date. te-20. 0 �QQ Permit Number:015qS
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=RECEIVEDBuilding Permit ApplicationPlanning and Development ServicesBuilding and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential X
PERMIT APPLICATION FOR: Roof
I_
PROPOSED IMPROVEMENT LOCATION:
Address: 1212 WINTERS CREEK RD PALM CITY FL 34990
Legal Description: HARBOUR RIDGE PLAT 17 TRACT G-10SAND PINE VILLAGE LOTS 7 AND 8 (OR 3805-2568; 2571: 3832-2586, 2588)
Property Tax ID #: 4423-701-0011-000-3
Site Plan Name:
Project Name: PAGE REROOF
Setbacks Front Back:
Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
RESIDENTIAL REROOF l �' o (� ��-7-2�ro 722.a R: �, 6cN=
Haaitionai worK to De errormea unaer tnis permit— ci
0HVAC _ Gas Tank ❑Gas Piping
11 Electric 0 Plumbing Sprinklers
Total Sq. Ft of Construction:J_1.
Cost of Construction: $ Liq lf!m . ob
apply:
_ Shutters
Generator
S Ft. of First Floor: _
Utilities:Sewer Septic
Lot No._
Block No.
QWindows/Doors
R] Roof Roof pitch
Building Height:
OWNER/LESSEE:
CONTRACTOR:
NameJONATHAN & PATRICE PAGE
Name: ARTHUR FRANK
Address:1212 NW WINTERS CREEK RD
Company: ROOFING SYSTEMS OF FLORIDA, INC.
City: PALM CITY State:FIL
Address: 583 105TH AVE N SUITE 9
Zip Code: 34990 Fax:
City: ROYAL PALM BEACH State: FL
Phone No.772-336-0711
Zip Code: 33411 Fax:
E-Mail:
Phone No. 561-795-5566
Fill in fee simple Title Holder on next page if different
E-Mail: ADMIN@MYROOFSYSTEM.COM
from the Owner listed above)
State or County License: CCCO29554
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:JON
Address:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:5
City:
BONDING COMPANY: Not Applicable
Name:
Address:
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 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.
Signature'of Contractor/License Holder
S g ture-of-Owner-/-L-essee/Contractor-as-Agent-for-Owne
STATE OF FLORI A
STATE OF FLO DA
COUNTY OF � r.�)►.
COUNTY OF r ,koa
The forgoing instrument was acknowledged before me
this day of 26& by
The forgoing instrument was acknowledged before me
thisMNay of 20 Xk by
J Ponc
[��ar 7 s7n,ny-,
6
Name of person makihostatement
Name of person,Making statement
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced 'Ct [)L
Produced
ignature of No ry Public- State of Florida)
gnature of Notary ublic- State of Florida )
Commission No. , ' � �g p a LWbaw
� = Gafim i #GGi85434
ida��.atohaw
Commission No. � �'; Comtr��'#GG1135434
Expires: Febuery 13, 2022
-�` ?+= Expires: Febuery 13, 2022
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Rev. 8/2/17