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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
i
Date:_I I 1 Permit Number:
REC
® Nov x 201$
Building Permit Application
Planning and Development Services
ST. LUCIQ �96'li� 1�.��' 11
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (1772) 462-1553 Fax: (772) 462-1578 Commercial Residential XX
PERMIT APPLICATION FOR: Roof '61��r
�,�PROPOSED IMPR®U,EMENT LOCATION ,
AA,41-- 413 OLEANDER AVENUE. FORT PIERCE
Legal Description: RIVER PARK - UNIT 2 - BLK 17 LOT 19c��le (�
Property Tax ID #: 3419-510-0208-000-9
1
Site Plan Name:
Project Name: WELSH/REROOF
Setbacks Front Back: Right Side: Left Side:
Lot No.
Block No.
pETAILE?D DESCRIPTION OF WORK'"
TEAR OFIIF SHINGLE, RE -NAIL DECK. INSTALL NEW OWENS CORNING DURATION SHINGLE
(FL#10674.1) ROOF SYSTEM - 28SQ OVER 30# FELT (FL#12328.7). ON FLAT PORTION INSTALL
POLYGL ASS W-140 (FL#1654.1) - 7SQ
CON'STR,UCTION FNFORIVIATION grr
wo
�HVAIIC Gas Tank
Electric ❑_ Plumbing
Total Sq. Ft of Construction: 3,500
Cost of Construction: $ 12,900
under this permit — check all apply:
❑Gas Piping Shutters ❑ Windows/Doors
❑ Sprinklers Generator Roof 4/12 Roof pitch
S Ft. of First Floor: 2,321
Utilities:InSewer OSeptic Building Height: 1 STORY
Q1NN`ER/LESSEE a
,
CONyTR►CTOR A4,
Name TODD WELSH
Name: KYLE WHITE
Company: J.A. TAYLOR ROOFING INC
Address: 302 MELTON DRIVE
Address: 221 OLIVE AVE
City: PORT ST LUCIE State: FL
Zip Code: 134952 Fax:
City: FORT PIERCE State: FL
Phone No. 1, 772-812-3113
Zip Code: 34982 Fax: 772-468-8397
E-Mail: TLWELSH@BELLSOUTH.NET
Phone No. 772-466-4040
Fill in fee simple Title Holder on next page ( if different
E-Mail: NADINE@JATAYLORROOFING.COM
State or County License: CCC1325895
from the Owner listed above)
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEIUIENTALCO�NSTRUCTIC?N�EN
"INFO,
,
DESIGNER/ENGINEER: of Applicable
Name: '
MORTGAGE COMPANY: ( mt Applicable
Name:
Address:
Address:
City: State:
Zip: I Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ of Applicable
Name: I
BONDING COMPANY: _ of Applicable
Name:
Address':
Address:
City:
City:
Zip:
I
Phone:
I
Zip: Phone:
OWNER/ICONTRACTOR 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 C aunty 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 inspectioR. If you intend to obtain financing, consult with lender or a rney before
commencing wording your Notice of Commencement.
Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY CIF STLUCIE
The forgoing instrument was acknowledged before me
this 8TH day of NOVEMBER 201S by
KYLE WHITE �NIlIIIII/l
Name of person making statem \� PQ� • 9�c ��f,�
Personally, Known xx OR Produceeder�tticajy'•.`S9
Type of Identification • �O�ember q o
Produced _ =o, �a�9�,g
` w en •
say o*
#FF 936050
(Siinaturellof Notary Public- State o�Floricf'�,�),�Q[%0_•.cr.
Commission No. _ FF 936050 (Seal)
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTYOF STLUCIE
The forgoing instrument was acknowledged before me
this 8TH day of NOVEMBER , ff by
KYLE WHITE
Name of person making statement V%%1111011111q,
Personally Known xx OR Produced a�1 i� .4V
Type of Identification `��``� ���M>,SS(py• �' �i
Produced �G ember is E/o ;
9m a
r w°
DiU O IEFF 936050 :
of Notary PubYc- State of
Commission No. FF 936050
REVIEWS FRONT ZONING SUPERVISOR I PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLET
Rev. 8/2/17