HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL 'pPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
MAI Permit Number:
SCANNED'
W t� LOO� .� �� RECEIVED
��. �.&�� @ PSI / . AUG 17, 10j�
_0Building Permit �►pp�ication
Plan ing and Development Services Pe St. Lucie Coent
County
Buil ng and Code Regulation Division
230,Virginia Avenue, Fort Pierce FL 34982
Phope: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PER �'ITAPPLICATIPN FOR: Roof
PRO ; OSED IMPROVEMENT LOCATION:
Addre s: I DL41 D ()I- _AVE, F ' �IQ►n� FL
1r�
Legal 1 escription: to � qON Zc o T arS (/2 or1`I !& (ice SW �+} Crt SW �/a%- Of Sc-c-
Propel) Tax ID #: J 41 331 -CM-1; -13 l lr!� -0I - Lot No.
Site Plan Name: N/A Block No. ,
Proie t Name: N/A
Setbi3 s Front N/A Back: N/A Right Side: N/A Left Side: N/A
DET [LED DESCRIPTION OF WORK:
W 4_ v� % \,\ *ems � -�- e x kiA- \v5��v1�`� roorF alp -tL.� 'f' _O r bc._\bA\r
oM Cr
Nccv.- O'PF A-0 vv�w C�ao�Q- - 1w L1 O, SrP, ux\aK4r\qy wee v +. i n-6rV.,.1\
N -V vvv,+oA r Ooi t v\3 6Aq6kXV1A .
CON TRUCTION INFORMATION:
tt 'ona wor to e e orme un er t is perms - c ec a apply:
_ VAC � Gas Tank Gas Piping _ Shutters a Windows/Doors
Electric FlPlumbingSprinklers ElGenerator Roof E Roof pitch
Total -Iq. Ft of Construction: S . Ft. of First Floor: N/A
Cost of Construction: $ I 2'LS.QD Utilities.
�Sewer Septic Building Height: N/A
�
OWNER/LESSEE:..,,
..
CONTRACTOR:
Nam
�. :Ql�
:Name: Ch`ristoplie� Collins `
Add r
s tb`P :t.I _ Qr pll!VIL
Company " :Collins'Roofirig!lnc. Y
City:
i.ty.
n :..q.._ State:
Addfdss 'P.O' Box*i'2867,�t
r
Zip C
,,
de: �' 2�2 Fax: N/A
K
`City: "FtRiercek a� s• L•.� r��,- State: FL
Phon
No. N/A .
Zip Code: 34979 Fax: 772-489-6505
N/A.
E-Ma
Phone No. 772-201-1352
fee simple Title Holder on next page ( if different
E-Mail: collinsroofinginc@gmail.com
Fill in
from
i�e Owner listed above)
State or County License: CCC-058011
If valuo of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION'LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
Name:
Address:
City:
Zip: Phone
'
_ Not Applicable
State:
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
'City: R. Pierce
Zip: Phone:
State:
I I
FEE SIMPLE TITLEHOLDER:
Name:
Address: P.O. Box 12867
City:
Zip: Phone:
_ VOrNot Applicable
BONDING COMPANY:
Name:
*VrNot Applicable
Address:
City:
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.
Inconsideration 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 boldinermit applications are exempt from undergoing a full con - rencyrevi w• errt"'1 s,
accessory ctures, sw Aences, walls, signs, screen rooms and , cessory use another non-resi ntial use
WAR NG TO OW R: Your failu to Record a Notice of
imp ovemente
y ur property.Notice of Commence
b ore the fir ection. ou ntend to obtain finanl
mmenci w or re din our Notice of Commer,
Signature of Owner/ lessee/Contractor as Agent for Owner
STATE OF FLORIDA �� f
COUNTY OF llAON
The forgoing instrument was acknowledgebefore me
i day of 20 `< by
HS
Name of persor�making statement
Personally Known nZ/ OR Produced Identification
Type of Identification
Produced
Kencement a r ult in your payi twice for
t must be/ee6rd d and posted the jobsit
consultAA leAd y before
2nt.
TgnaWre-df•(3CFtractor/License Holder
STATE OF FLORIDA r1i..
COUNTY OF
The forgoing instrurpent was acknowledged before me !
this day of Af A 4Z 20M by
I
c
Name of person ing statement
Personally Known OR Produced Identification
Type of Identification
Produced `
(Signdtary lic- State of Florida) JSigna r of t - Public-
Commission No. EY FRENCH
l �;' N� Commission o.
. � : o lic - State of Florida
• : ' Commission # GO 167258
oYF My Comm. Expires Dec 11, 2021
REVIEWS FRONT TZONING SUPERVISOR PLANS VEGETATION
COUNTER REVIEW REVIEW REVIEW REVIEW
DATE
DATE
COMPLETED
Rev.8/2/17
CASEYFRENCH
3�y�Public - State of Flori
( btfrfnission # GG 167258
MY Comm. Expires Dec 11, 2C
Bonded Through Nalional Natarv&!
SEATURTLE MANGROVE
REVIEW REVIEW'