HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAPPLICABLE INFO MUST BE CIF LETED FOR APPLICATION TO BE ACCEP7EU\
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Date: ��O�F�CI Permit Number. Ft0ii'Mm
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Building Permit Application
Planning and Development Services epn
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 J
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: Roof
PROPOSED IMPROVEMENT LOCATION:
rC�-�
Address: L0 R (V-\CkyC7 Pci1t F+ APT-CCP F —
-.;n N 1 51 -P�cE n I RRF-4-
Legal Description: A4 C (oro-F+ rtF w 31) 40 3jR of
5 21g �P+ of Sw (/i-.
Property Tax ID #: ('� (� ) 3� — 7�' ��' Lot No.
Site Plan Name: N/A Block No.
Project Name: NIA
Setbacks Front N/A Back: NIA" Right Side: .N/A Left Side- NIA
DETAILED DESCRIPTION OFWORK:,
We. W I R �e oar o� _-ln '''' ex� Sv.� d2 r0a� , na.t o(� d ecl� � Co 2
V
0.nCk re. r-poF W r1k ST- L. CQ yw�zv`lJ-� C".r +rv�tkai.
CONSTRUCTION INFORMATION: _. t
un ert ispermitc ec a appy:
Additional wor to jene orme —
❑Gas Wi
❑HVAC L__IGasTank Piping _Shutters ndows/Doors
❑Generator EN
❑Electric 0Plumbing ❑Sprinklers Roof Roof pitch
Total Sq. Ft of Construction: 1, .0m lip S�Ftj of First Floor: N/A
❑ NIA
Cost of Construction: $ 560 Utilities: LJ Sewer Septic Building Height.
OW N E RAESSEE:
CONTRACTOR:
Name 4 S CAAVNR
Name:. Christopher Collins
Address: (D22$ InYIO RCS
Company: Collins Roofing Inc.
City: Vbr2�2 P Rpr r _ State: la,
Address: P.O. Box 12867
Zip Code: ill % ?6 Fax: NIA
City: Ft. Pierce - State: FL
Phone No. IV/A
Zip Code: 34979 Fax: 772-489-6505
E-Mail: NIA
Phone No. 772-201-1352
Fill in fee simple Title Holder on next page (if different
E-Mail: collinsroofinginc@gmail.com
from the Owner listed above)
State or County License: CCC-058011
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
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 TITLEHOLDER: VONot Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address: P•O.Box 12867
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 that
or and covenants 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 b ' ermi plicati s are exempt from undergoing a full co n ' eview: roo dditions,
accessory str tures, s ming pools, f ces, walls, signs, screen rooms an ccessory use t other non- sidential use
WARNI G TO O R: Your failur to Record a Notice of Co encement r sult in your pa ng twice for
impro ements y ur property. Notice of Commence nt must be or d and ted o the jobsite,
bef a the fir in ection. o Intend to obtain finan ng, consult le der ttorn y before
co menci w ore in our Notice of Comm cement.
Sign of Owner/ Lessee Contractor as Agent for Owner
Signature ontractor/License Holder
STATE OF FLORIDA
STATE OFF LORIDA
COUNTYOF Cat e�Qlf.l
COUNTYOF l3% LLCCc P
Theing instrument was acknowledged before me
Q
The forgoing instrument was acknowledged before me
thi ay of !� ( 201by
this d/a�y ��fLCt�! 2Q(� by �nQ
(of
Name of personynaking statement
Name of person making statement
Personally Known V OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
l (7/YVIC�LAn
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(Signature of. otary Public-Stat��Florida)
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(Signature Notary Public -State of Florida )
Commission No. 4
DINAHGCUSHMANk4°""••„s
mmission No.
Notary Public -State of Florida
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DINAHGCUSHMAN
_�: t Notary public-
State of Florida
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Rev.8/2/17