HomeMy WebLinkAboutAPPLICATION FOR ROOF PERMITFee DuY-
1) 1 Permit # ff /f)
St. Lack County Buildi *n 'g & Zoning
2300 Virginia Avenue. Ft. Pierce, FL 34982-5652
SCANNED Tel. 772-462-1553
BY
st. iLucoqq Cc&* �?LICATION FOR ROOF PERMIT.
E REVERSE SIDE FOR INSTRUCTIONS
1. L.ochAM/SiteAddress: 14,6
2..'Parcel [D-Number: bi -o-6 0
3. Des
4. Total
fficeUse-
Only
-Section
Township
Range
.Ma Pa a
Zonin
LAUdUse:
Initials.:
q
Q
tion of Project or Work Activity: -fe !�4,'i-,,Je5 LOIC'e, 1"N
oof Area,(square feet): 5. Roof Pitch:
6. Type ORooif.
.F.T.Fiberglass Shingle
FIT, a'r & Gravel
E10ther .(specify)
ElBarrel/Tile Ceramic
00-:0-dified Bitumen
❑ Wood Shake Shingle.
EN Metal
LJ N.O.A — Product Approval required for All Types of Roofing Material
All "Commercial Roofing Requires Design by an Engineer or Architect (two Sets)
7. Owner Information. 8. Contractor. Information
Name: f'n*f_.. t d �e C a.,,N Ft Reg/Cert #: �-65-0
Add ress:,�' County Cert#:
City: I�Dr State: Business Name:
Phone: 7 Fax Z 1�' Zip; Phone 7 7 4f7l
9. Value of Construction: $
Note: D ry-in and, Final Inspection Require
A ditional inspection may be required per Product Appro.va
OWNEWS-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.
PRINT QUALIFIERS/OWNERS NAME SIGNATURE OF QUALIFIER/OWNER
STATE OF FLORIDA, COUNTY OF, Z, ACKNOWLEDGED BEFORE ME TH�is: DAY OF
qe�&, 20-a BY Z( _I di .. ERDS YgALL-�"_MVN TO ME. OR WHO. HASPRODUCED
A AS IDENTIFICATION.
FALLON'YEMER
NOtery PublIfitacRaI6 of Florida
SIG9. TURE OF NOTARY TYPE OR PRINT NAME OF NOTARY My "Comm._ Op.'Ded. 11, 200
TITLE: NOTAR PUBLIC COMMISSION NUMBER Comm. No. DD 49M3
V
St. Lucie Cou ty Roof Permit Application rev. 7/18/05 dmg