HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date;PormitNumber:
Building Permit Application
planning and Development Services
Building and Code Regulation Division
C2:3:0:0:1,iia�rgini34982—
,Avenue, Fort Pierce FL 7
Phorie: (772) 462-1553 Fax: (772)462z1578 Commercial Residential xxx
PERMIT APPLICATION FOR: Roof
1',PRQP05ED,1lVlPRQVEjMftW LOCATION 2,
Address: 12770 NW Mariner Court, Palm City
Legal Description: Harbour Ridge Plat 4 Tract B I OR 4136-1284)ref ; * leCCU
Property Tax ID #: 4425-603-0009-000-1 Lot No.
Site Plan Name: Block No.
Project Name: Hill Residence
Setbacks Front Back: Right Side Left Side:
Re -Roof (Tear Off Tile, Install new 30# and 90# hot mop applied, install new accessory metals and
new tiles using AH-1 60 Foam.
onai worK TO De nerTormea
HVAC LJGasTank
Electric 0 Plumbing
Total Sq. Ft of Construction: 1800
Cost of Construction: $ 8,580.00.
1
unaer tnis permit — ci
E]Gas Piping
OSprinklers
all tl3at apply:
ElShutters
E]Generator
Sq. Ft f First Floor: L. o irs
Utilities: liSewerE]Septic
1:1 Windows/Doors
21 Roof6/12 Roof pitch
Building Height: 15'
'RXbCF
72
AS
,
A F",
Name David C Hill
Name: Juan Martinez
Addre'ss:69 Rowell RD
Company: Total Roofing Systems Speciallsy
Address:
City: Lancaster State:NH
Zip code- 03584 Fax: 772-872-8033
City: Stuart State:FL
1 772-872-8030
Phone No.
34997 772-872-8033
Zip Code: Fax:
Phone No. 772-872-8030
E-Mail:Samira@totalroofingsystems.net
E-Mail: Samira@totalroofingsystems.net
Fill in fee simple Title Holder on next page ( if different
from Ithe Owner listed above)
State or County License: CCC1 330788
It valu e of construction is 52500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEtN LAW INFORMATIONV.
DESIGNER/ENGINEER:
T Not Applicable
MORTGAGE COMPANY: _
Not Applicable
Name:—
Name:...
Address:
Address: y
City: Lancaster
State:
City:
State:
Zip: l Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Not Applicable
BONDING COMPANY:
Not Applicable
Name:
_
Name:
Address:
Address:
City:!
City:
Zip: Phone:
Zip: I Phone:
I
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 recQrding your Notice of Commencement.
Si ure of Owner/ Lessee/Contr a ntbr-owner Sign of Contractor/License Holder (_____
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing instrument was acknowledged before me
this J— day of 0C_+obe_r 20) % by
Name of person making statement
Personally Known OR Produced Identification
Type of Identification
Produced
I ,
(Signature of Notary Public- St to of Woricla )
Commission No. q& 19 7 3 I K (Seal)
arv'a;a•. SAMIRA M. GONZALEZ
Co mission i GG 197318
REVIEWS FRONT GMyco rS.t�F3Mk6®Rf
COUNTER Ft'EV > dthr ghR4jvg4!!WtaryA
RECEIVED
DATE
COMPLETED
Rev. 8/2/17
The forgoing instrument was acknowledged before me
this isfi day of O C t-O b-e r 20 1& by
Name of person making statement
Personally Known OR Produced Identification
Type of Identification
Produced
(Signature of NotaryiYublic- SMte of Florida )
Commission No. GCT lq _731f
LANS I VEGE'
VIEW REV
SAM�GONZALEZ
Public -State of Florida
-0
-rii6 _; _ Ma 18, 2022