HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE_C_O_M_PLE_ COMPLETED FOR APPLICATION TO BE ACCEPTED - 11 Q
Date: Permit Number: l 1
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o Building Permit Application120)9
Planning and Development Services ty, Permitting
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential X
PERMIT APPLICATION FOR: Roof Q;2q/
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�000111127
wAddress:
8401 Fort Walton Ave, Ft. Pierce, FL 34951 �4d,
Legal Description: Lakewood Part - Unit 6 - Blk 57 Lot 28 (Map 13/02S) (OR 1858-2935;2093-594;2416-1749)
Property Tax ID #: 1301-606-0028-000-9 Lot No. 28
Site Plan Name: Block No. xi7—
Project Name:
Setbacks Front Back: Right Side: Left Side:
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Remove existing shingle roof and install new metal roof
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Be
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itiona wor to e e e ormun ert is permit— cneCK all that apply:
OHVAC Gas Tank []Gas Piping Shutters Q Windows/Doors
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Electric FI jj
Plumbing Sprinklers L] Generator Roof 8/12 Roof pitch
Total Sq. Ft of Construction: 2000 S Ft. of First Floor:
Cost of Construction: $ 10400 Utilities:Sewer Septic Building Height: 16'
O it R LE St � 01%
Name Rudolph Kirchner
,��+ITR�A�L�TO�t � g R 11-
Name: Jamie Cisco
Address: 8401 Ft. Walton Ave
Company: Sunshine Roofing LLC
City: Ft. Pierce, State: FL
Address: PO Box 1083
City: Palm City State: FL
Zip Code: 34951 Fax:
Phone No. 772-321-4212
Zip Code: 34991 Fax:
E-Mail: bmx665@msn.com
Phone No. 772-260-8195
Fill in fee simple Title Holder on next page (if different
E-Mail: sunshineroofingllc@gmail.com
State or County License: CCC1327796
from the owner listed above)
If value of construction is $2500 or more, a RECORDED Notice of commencement is required.
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DESIGNER/ENGINEER:
Name:
_ Not Applicable
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
Address:
City:
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLEHOLDER:
Name:
_ Not Applicable
BONDING COMPANY:
Name:
_Not 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 inspection. If you intend to obtain financing, consult with lender or an attorney before
commencine work or recordine vour Notice of Commencement.
a
Sign ture of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF St. Lucie
COUNTY OF SL Lucie
The forgoing instruWent was acknowledge,( before me
The forgoing instrument was acknowledge¢ before me
this Mdayof JQLf1UGr: 20L by
thisf�dayof :Unuar� 20L`I by
Rudolph Kirchner
Jamie Cisco
Name of person making statement
Name of person making statement
Personally Known OR Produced Identification
Personally Known X OR Produced Identification
Type of Identification
Type of Identification
Produced license
Produced
(Sign - ure of Not Pub)ii tatte,q pidq}
(Signa ure of No6 ubli State of I
y Jy+x* np Notn �uAI`c Stnto of Florida
Commission No. 4 °,. h)`tfo Marll� e@� le0el
d rn� Notary Pugl'o S•.Q1e of Florida
Commission No. A' ° �+ Marilyn kSs?y�.'V
My Cmmnllrninn FF 230170
fy My cammisslon FF 230179
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oin°'� Lxpiros 05120,2019
o Expires 03/28/2010
S_w... eA A
6 - x
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
55,1
Rev. 8/2/17