HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: I
R�EIV
DECComm
i I.101B
Building Permit Application pornitting De
Planning and Development Services St' Lucie Count,,
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential xx
PERMIT APPLICATION FOR: Roof
PROPOSED IMPROVEMENT LOCATION:
Address: 5000 SEMINOLE ROAD SCANNED
Legal Description: LAKEWOOD PARK - UNIT 3 - BLK 17 - LOT 1
Property Tax ID #: 1301-603-0001-000-5 Lot No.
Site Plan Name: Block No.
Project Name: HUNTRESS/REROOF
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK;
TEAR OFF SHINGLE, RE -NAIL DECK. INSTALL NEW JA TAYLOR ROOFING 5V CRIMP METAL
PANEL ROOF SYSTEM OVER 30# FELT LINDERLAYMENT.
CONSTRUCTIONINFORMATION:
❑HVAC
❑
Gas Tank
❑Gas
Piping
❑ Shutters
❑Electric
❑Plumbing
❑Sprinklers
❑Generator
Total Sq. Ft of Construction: 1,600
ScFt.
of First Floor: 864
Cost of Construction:
$ 5,800
Utilities:
Sewer
❑Septic
❑ Windows/Doors
Roof 4/12 Roof pitch
Building Height: 1 STORY
OWNERAESSEE: ; ,
=CONTRACTOR:"
Name KATHERINE HUNTRESS
Name: KYLE WHITE
Address: 10185 MULLER DR
Company: J.A. TAYLOR ROOFING INC
City: FORT
Zip Code:
Phone No.�
PIERCE State: FL
134945 Fax:
772-323-1010
Address: 302 MELTON DRIVE
City: FORT PIERCE State: FL
Zip Code: 34982 Fax: 772-468-8397
Phone No. 772-466-4040
E-Mail: K, UNTRESS@CITYOFPSL.COM
Fill in fee simple Title Holder on next page if different
from the Owner listed above)
E-Mail: NADINE aC'JATAYLORROOFING.COM
State or County License: CCC1325895
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUP PLEMENTALCONSTRUCTION LIENLAW INFORMATION:
DESIGNER/ENGINEER:
Name:
l iNot Applicable
MORTGAGE COMPANY:
Name:
Cum Applicable
Address:
Address:
City:
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
_ of Applicable
BONDING COMPANY:
Name:
_ of Applicable
Address:
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 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 in . If you intend to obtain financing, consult with lender n attorney before
commencih wor r r rdin our Notice of Commencement.
Sign ture o Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF 6TLUCIE
COUNTYOF BTwCIE
The forgoing instrument was acknowledge before me
The forgoing instrument was acknowledged before me
this 5TH day of DECEMBER 20 by
this 5TH day of DECEMBER 26JE by
KYLE WHITE \\\\\1\tlllllllf�/////
KYLE WHITE
Name of person making stat ` y�5 ........9 /�i�i
IC,
Name of person making statement \\\N\tnl1F M lffpj//
Personally Known xx OR Prodt7•• %
Personally Known xx OR Produced Id ;
Type of Identification
Type of Identification • •�\ZM\S �Nyc,•.,
er 1S2 p9:
Produced
Produced
•�2 OWN•
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sbp9. :
RFF936050
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44
(Signature of Notary Public- State of Flo rlffA/)USLI S1ii:\\\\\\N
(Signature of Notary Public- State of FloridIllfillia"iy��p •.; �rnn •F��
Ic Ale0\\\\\\
FF 936050
Commission No. (Seal)
FF 938050
Commission No. (Seal
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE I
COMPLETED
Rev. 8/2/11-