HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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Building Permit Application of meet
Planning and Development Services SCANNED ec `���9`GewGoXI
Build►ng and Code Regulation Division Lucie
P St.
2300 Virginia Avenue, Fort Pierce FL 34982 Lucie County
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: Roof
PROPOSED IMPROVEMENT LOCATION:,
Address: I n:1 Z5 S r e as) "y
Lnu'�ft ` Fi
• }3 er_\� S Q.0Nn� FL
Legal Description:' wf n, A (AC
!C 6I K C L(71-1-)
aOd eQ(.AOJ P O
COL-{ & -1,��� �,n_ C_Q►myY1C)0.P
t e.100
Property Tax ID #:
7
.. Lot No. I,
Site Plan Name: N/A
Block No. C
Project Name: N/A
Setbacl s Front N/A Back: NIA'_`Right Side:
N/A Left Side:
N/A
`:;DETAILED
DESCRIPTION OF WORK:'
We.
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CONSTRUCTION INFORMATION:
Additional work to be nertormed under this permit— check
❑HVAC Gas Tank. Gas Piping
all
apply:
Shutters
Windows/Doors
_
Electric
❑ Plumbing ❑Sprinklers
ElGenerator
_
Roof 3 ( Roof pitch
Total Sq1
Ft of Construction: 1 o
S . Ft. of First Floor:
N/A
Cost of
Construction: $ U 62-5.0b Utilities:Sewer
Septic Building Height: N/A
OWNER/LESSEE:
CONTRACTOR:
Name �ft
Address•
City: 3QRAr\
Zip Codee:
Phone
E-MaiI:IN/A
Fill in fee
from the
uo orIOI. -do
Name: Christopher Collins
Company: Collins Roofing Inc.
10-12-5 5. OCR= Dr
State: 1,
Fax: N/A
lo. N/A
Address: R.O. Box 12867
City: Ft. Pierce State: FL
Zip Code: 34979 Fax: 772-489-6505
Phone No. 772-201-1352
- E-Mail: collinsroofinginc@gmail.com
simple Title Holder on next page (if different.
Owner listed above)
State or County License: CCC-058011
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
I
SUPPLEMENTAL CONSTR ION':LIENIAW INFORMATION:: I
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: FL Pierce State:
Zip: Phone
Zip: Phone: II
FEE SIMPLE TITLE HOLDER: Not Applicable
BONDING COMPANY: _Not Applicable
Name:
Name:
Address: P.O. BOX12as7
Address:
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 followin gilding p it applic ions are exempt from undergoing a f concurre cy rev' v: room add ions,
accessor ruct res, imming pool fences, walls, signs, screen room nd accessory s o another non- esidential use '
WA ING TO NER: Yo a' ure to Record a Notice of C mencem y result in ur p ying twice for
i rover to your pr e . A Notice of Commence ent mus r orded a oste on the jobsite
b fore t st inspec ' If ou intend to obtain fina ing, co w' lend r n att rney before
omm i work gQr co ng your Notice of Comm ceme
�re fAw _ r. esee/_Co . [actor as,Agent for Owner
Si a ofi n ctoC/Licerise Hol r
STATE OF FLORIDA
STATE OF FLORID
COUNTY OF S4- G`t c; e
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this l0 day of b c'�Atr , 201k by
this 10 day of 20Lkby
Name of persona statement
Name of persona ding statement
ORng
Personally Known Produced Identification
Personally Known t/ OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature of N ary' �� Y�&te r
S o��f� �II� - State of Florida
'^ ^� Corn ICsslo # FF 22170E
(Signature of N' _ Inc- SSt to on aat of Florida
rr tt �. AN y Publ c -
cos Commission 22 708
Commission No. a ey, "�`
o, Plly Corn May 1 C, 2019
a : �z: f�
Commission N - - M. Expires4�i�j( i, 2019
°nn Bonded through National Notary Assn.
Bonded through National Notary Assn.
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE'
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
o
DATE
COMPLETED
Rev. 8/2/17