HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE
Date:
FOR APPLICATION TO BE ACCEPTED
PerrniVNumber: �� U i�U "
F__RE_CE1_VED_
Building Permit Application I OCT ® 3 2018
Planning and Development Services ST.. Lucie county, Pg��il li
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone:-(772) 462-1553 Fax: (772) 462-1578 Commercial Residential 141
PERMIT APPLICATION FOR: Roof
,E�j
PROPOSED IMPROVEMENT LOCATION: _ BY
Address:
Legal Description: 5VN�_rC1�C1 p� G_7_0. Z
Property Tax ID #: 14 ?2 - 965 - W R - ooc) - to Lot No._
Site Plan Name: NIA Block No.
Project Name: NIA
Setbacks Front NIA Back: NIA
1 DETAILED DESCRIPTION OF WORK:
Right Side: NIA Left Side: N/A
W c- -exts-hy- p�a�- S �� \� roo,� dower
W 4ad- v��e_ rw A\ V-\Sko'k o - Slf\- \.kr-de_r\"W
air Qk V inn kA 0'_ k r oo�il- \,-\n .
CONSTRUCTION INFORMATION:
Additional work to e performed under this permit —check all apply:
�HVAC 0 Gas Tank Gas Piping _ Shutters ❑ Windows/Doors
Electric ❑_ Plumbing Sprinklers ElGenerator Z Roof Roof pitch
Total Sq. Ft of Construction: 2-Z. 1P S . Ft. of First Floor: N/A
Cost of Construction: $ G!, 3 So.Od Utilities:�Sewer Septic Building Height: NIA
..OWNER/LESSE,E?. ...
CONTRACTOR:,,.,..._._,...
Name [.PA'GC
Address .1.b"Ti-'ter =_
Name: Christopher Collins'
Company: Collins Roofing Inc. !
City: i� (o YT P - stater
Zip Code: Fax: NIA
Phone No. N/A
Address: "P;0 Box 12I367.. "'...... ..
City: Ft. Pierce State: FL
Zip Code: 34979 Fax: 772-489-6505
Phone No. 772-201-1352
E-Mail: ,N/A
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above) -
E-Mail: collinsroofinginc@gmail.com
State or County License: CCC-058011
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTR'^ .
ON: LIEN LAWIN
FORMATION: - °
DESIGNER/ENGINEER: _
Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City:
State:
City: Ft. Pierce State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: -
Not Applicable
BONDING COMPANY: _Not Applicable
_
Name:
Name:
Address:
Address: P.O. Box 12867
City:
City:
Zip: Phone:
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.
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 accesso uses to another non-residential use
WARNING'iO OW ER• Y r u to Record a Notice of Comme ement m y r I ur paying twice fo,r
improv4ments to y property. A otce of Commencemen ust be rec ded and p ted on the jobsite
befor the first ' ection. If youeiend to obtain financin , consult ender or an attorney before
coencinl; or recordrg Notice of Commenc ment.
of Owner/ Lessee/Contractoras gent or Owner
Signature off Contractor/License Holder
STATE OF FLORIDA
l.l�l�_R�
STATE OF FLORIDA
COUNTY OF wcz'
COUNTY OF 1027
The forgoing instpuMent was acknowledged before me
The forgoing instrAynent was acknowledged before me
day Q 20)SL by
this CP-> day of�O (C— Q. , 20��' by
this of
PA-f,7rSs b e\AZ' z- R COD
Name of person making statement
Name of person making statement
Personally Know OR Produced Identification
Personally Known OR Produced Identification I i
Type of Identification
Produced B'QRfa-
Type of Identification
Produced
�q5 )\-2�' C-)
GCC0`'30
6_agf l T
(Signature of Notary Public- State of Florida
(Signature of Notary Public- State of Florida
Commission No. ;•''�° GENEVIEVED
1
..'. MIN IEVED.BpRNETf
Commission No. _ ; gomi GG160647
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
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DATE
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DATE
COMPLETED
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Rev. 8/2/17