HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONi
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rALLAP
Date:1II AA 36
INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
RECEIVED Permit Number:
Planni g and Development Services
8uildi and Code Regulation Division.
2300 Virginia Avenue, Fort Pierce FL 34982
Phon I�f (772) 462-1553 Fax: (772) 462-1578
AUG 3 0 2018
i lication Sk�tS Commercial Residential
Residential
PER
IIT APPLICATION FOR:
Roof
PROP;��
SED IMPROVEMENT
LOCATION:
Addres lag G _acyN ` AVZ . POY' swr%* 1,.����-. 3�52 st.Lucie U�YC RY
Legal Di scription: �a V sV 0 rW_ - `AY% 3 - 9\1L Zta L-0+ 1 �1
ProperIII Tax ID#: ?JIB ���—b��1Ln—C�C��-[� Lot No. �9
Site PI Name: Site Block No. 2L9
Project ame: N/A
Setbac s Front N/A Back: N/A Right Side: NIA Left Side: N/A
,DETA;,LED DESCRIPTION OF WORK:
T 69 the e k-s+%nJ Sh�h�1��F�o�� roo NWl GPP kV, -A- ex�shr� d n�
e . v�1 e.5 o�xvc� SA Wr4uv`ne�n 0.'� r�
CONSTRUCTION INFORMATION:
iti a work to e nerformed under this permit check all apply:
❑ VAC Gas Tank ❑Gas Piping _ Shutters ❑ Windows/Doors
❑_fi ectric 0 Plumbing Sprinklers Generator P Roof y IZ Roof pitch
I/
Total SI . Ft of Construction: 7-Z>� 3 S . FtFtj of First Floor: N/A
I RAC
Cost o onstruction: $ �� OI �V . () Utilities: LJ Sewer Septic Building Height: N/A
�1
"'OW14
R/LESSEE:
CONTRACTOR:
Name
Addres
City: '
Zip Col
Phone
E-Main
Fill in f
from tl
Name: Christopher Collins
Company: Collins Roofing Inc.
Address: P.O. Box 12867
: I Og 15eg.0m 1Prye_
r State:
e• 3*q52_ Fax: N/A
o. N/A
City: Ft. Pierce ' State• FL
Zip Code: 34.979 Fax: 772-489-6505
Phone No. 772-201-1352
E-Mail: collinsroofinginc@gmail.com
NIA
e simple Title Holder on next page ( if different
le Owner listed above)
State or County License: CCC-058011
If valuer I construction is.$2500 or more, a RECORDED Notice of Commencement is required.
III
SUP,;
jLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESI
Nam a
Addrill
City:
Zip: III
NER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
s:
Address:
� State:
Phone
I
City: R. Pierce State:
Zip: Phone:
FEE S
Nam
Addi-
City:
Zip:
III
PLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: _Not Applicable
Name:
5: P.O. Box 12867
Address:
City:
I
111 Phone:
Zip: Phone:
"
OWNEI CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify hat 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 i n conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structuri . Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consi' eration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
in accor l ance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The follo wing building permit applications are exempt from undergoing a full concurrency review: room additions,
accessol stru swimm' ols, fences, walls, signs, screen rooms an Gesso ses to er non-r 'dential use
WJRG TO O R: Your f ilure to Record a Notice of Co mencement m result in your pay' g twice for
imment your prope . A Notice of Commence ent must b rded and posted n the jobsite
b he ' spection. ou intend to obtain fina ing, cons it lenderoranatto ey before
nd rk or r di a vour Notice of Comm ncement i- /%
as Agent for Owner Signature of Contrac%ar/l�i—cense Holder
STAT OF FLORIDA STATE OF FLORIDA
COU TY OF Sc,: e COUNTY OF Z g C,, -2
The forgoing instrument was acknowledged before me
thi day of s/ ( 2011 P- by
r S /sec C- I C
Name of person53aking statement
Persoi Ily Known `* OR Produced Identification
Type t Identification
The forgoing, instr ment was acknowledged before me
this 3kday of .s 2ql— by
Name of personmaking statement
Personally Known ✓✓ OR Produced identification
Type of Identification
Produced
Si nature of Not fe o rid ``
(Signs lure of t Public -State of Florida) (g .oa,p. • ATHY ROBERTS
a° �e` Notary Publ to of Florida
Comm sion ,,,,,u. _r.ATHY J &ARTS Commission No. �S�.
� e Commiss�o e���F 221708
Notary Public - State of Florida
commission # FF 221708 '. °;� PJIY Comm. Expires May 10, 2019 y
s�Foii°`�,
Bonded through National Not Ass
Y y nnin
Assn.
REVI�111W
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DATE
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Rev. 8/V17