HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONPill
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial
ALL APPLICABLE INFO MUST BE Wnnr�LETED FOR APPLICATION TO BE ACCEPTEo' (�
Date: Permit Number: ✓! -Ga�' n5
RECENED
Building Permit Application
Permitting ooPortmant
St. Lucle county
Residential iL
JAN 2 41019
PERMIT APPLICATION FOR: Roof III
PROPOSED IMPROVEMENT LOCATION: .0. "gvlln._ III
Address:
Legal Description:
Property Tax ID #: 2� -�(� �sX��l�o� -J Lot No. lD�
Site Plan Name: N/A Block No.
Project Name: N/A
Setbacks Front N/A Back: N/A
Right Side: N/A
LeftSide: N/A
DETAILED DESCRIPTION OF WORK:
W Q 0 teox Olr `�- Qk15fihn Sh kyl k I r\0A ec 1c . co e
CkN'N re-. Y'eop w tt-h A. 5ft V_nQl zY
CONSTRUCTION INFORMATION:
AClaitionalworKtOrienertormed under tispermit-check all apply:
E1HVAC Gas Tank ❑Gas Piping _Shutters Windows/Door
Electric Plumbing nSprinklers E]Generator Roof E - Roof pitch
Total Sq. Ft of Construction: 4-0k V / 1-4 '
Cost of Construction: $ lAN W
SgI�Ft.I of First Floor: N/A
Utilities:nSewer Septic
Building Height: N/A
OWNER/LESSEE:
CONTRACTOR:
Name
Name: Christopher Collins
Address:]
Company:` Collins Roofing Inc.
City: . 1 State: F1,,
Zip Code: MW Fax: N/A
Phone No. N/A
Address: P.O. Box 12867 -
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 requirea.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
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: P.O. BOX 128e7
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 such
prohibit
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 str res, wimmi fences, walls, signs, screen rooms and anot non-residential use
WARNI TO OW : Your failu a to Record a Notice of Co enceme By esult in yo r paying twice for
i Ipr ements t ur property. Notice of Commence nt must r o ed an po ted on the jobsite
bef a the fir ection. o intend to obtain fina Ing, cons t th rider an torney before
co mencin o or rec your Notice of Comm ncement
wne essee/Contractor as Agent for Owner
Sign Co icense Holder
STATE OF FLORIDA
STATE OF FLORID
COUNTY OF 6J LLxC r1_e.
COUNTY OF , I_iAO J,P
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
thisdayof rjua 20f_q by
thisp day ofYlr� 20jg by
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Name of person making statement
Name of pers making statement
Personally Knowny OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
CLA11___
(Signaturl of N
(Signature of Notary Publi
Commission No.
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_:. Notary Public-Stal�e��ofFlAgrida
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Commission No. �. • No��Pg¢gc-State of Fbrtda
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Rev.8/2/17