HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL AP , LICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED —t
Date- �AA �� Permit Number: \A d,— aL 15
nu UGANNED
BY RECEIVED
Building Permi��i�►pplication JUL 1VOIE
Planning and DevelopmentServices
Buildi g and Code Regulation Division S1. Lucie County, P ri
21 '1Irginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PER '+ IT APPLICATION FOR: Roof-
PROI OS ED'IIVIP,ROVEMENT'LOCATIQ' N
ft r
. .
Addre ss: zl off' `5 39
'
Legal Qescriptinn:
Prope4`ty Tax ID #: ��� " tyl i�i-'� '{ '1 !l 1 Lot No. 3
Site Pan Name: N/A Block No.
Projeclt Name:. N/A
N/A N/A N/A NIA
Setblcks Front Back: Right Side: Left Side:
DET�4ILED DESCRIPTION,OF WORK
f
O-PF t�%L_ exl5-h : r'�ofi own t b -H�e c
Je i <<
re n k -kb : Lwr-r� code . Re. MDe 1�n� home w can
a e frUh.5►v,- brVwn . 5,
CONSTRUCTION INFORIVIAlION
Additional work to e e orme under tis permit —check a apply:
I HVAC E] Gas Tank Gas Piping _ Shutters Q Windows/Doors
UElectric EiPlumbing Sprinklers ElGenerator Roof I I Roof pitch
Tota'� Sc. Ft of Construction: I LOI� S . Ft. of First Floor: N/A;'
Cost
;of Construction: $ Q Utilities: _ Sewer ElSeptic Building'Height: '
O.V1°INER/LESSEE 4.
,CO'NTRACTOR
NanNe
2.
Name: Christopher Collins
ess: 5.
Ad
Company: Collins Roofing Inc.
,i
,j State:
Fax: N/A
Address: P.O. Box 12867
Cit
Zipl!tode:
City: Ft. Pierce State: FL
Ph
E-Mail:
ne No. N/A
N/A
Zip Code: 34979 Fax: 772-489-6505
Phone No. 772-201-1352
fee simple Title Holder on next page ( if different
E-Mail: collinsroofinginc@gmaii.com
Fill jn
froil"
the Owner listed above)
State or County License: CCC-058011
If v#!ue of construction is $2500 or more, a RECORDED Notice of Commencement is required.
S UIlk
PPLEMENTAL C,ONSTRUCT'ION LIEN LAW
ORMAT '
DESIGNER/ENGINEER:
_Not Applicable
MORTGAGE COMPANY: _
'Name:-
Not Applicable
Name:
`
Address:
Address:
City:
State: 1
City:, -,Ft. Piercd,
State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLEHOLDER:
_ Not Applicable
BONDING COMPANY: _Not
Applicable
Name:
Name:
Address:
Address: P-0- Box 12867
City:
City:
Zip:. Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain
I certify that no work or installation has commenced prior to the issuance of a
permit to do the work and installation as indicated.
permit.
St. Lucie County makes no representation that-isgranting a peermit will authorize the permit ho�der 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 Jany 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 b mit applications are exempt from undergoing a full+concurrenc}r re ' w: room' -ad ditions,
accessory uctures, swim in s, enc walls, signs, screen rooms and acces uses to a t - ial use III
W ING TO OW : Your failure to cord a Notice of Comm ement may uIt in your paying t. ce for
i provements r roperty. No ce of CommenceMe must be re e d posted
�oe�ny th jobsite
afore the i e ion. If t d to obtain financ' g, consult le er r an at / fore
comma �t'k re vo Notice of Comma cement.
1I
Signa ure.of Owne _see/Contractoi as-Ager t'foi Owner?
Slgnaturefof Gontractnr/ c1 ense Holder
STATE OFAORIDA `
S
STATE OF FLORIDA
COUNTY OF .G�'4-- - ';
COUNTY OF
The f c ing instru e t was acknowledged before me
this day of 20� by
The f r oing instru e t was acknowledge before me
this day of 20 by
y
—1A04:ZY
Name,.of person making statement
Name of person making statement
Personally Known OR Produced Identification
Personally Known OR Produced Identification
i7 k �3
Troeofidentification
Pr r�
Sta
"�q
Notary IC�
" Commission # GG J69025
"'� M xores Dec 16, 2021
; roiP"` •; BELINDA DA RDEN= -
. ; �` _ ►Y Publics State of Florida ,
N�
c Bonded Uxough National NotaryAasn.
, # GG 169025
mm.
rMitare-oto ary Public -State of Florida
engrf aWW�i• a Florida )
Commission No. (Seal)
Commission No. '(Sea[) ' I
. , I!
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE'
i
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
tev. 8/2/17