HomeMy WebLinkAboutBUILDING PERMIT APPPLICATIONALL APPLICABLE INFO MUST BE COM'rcr tED FOR APPLICATION TO BE ACCEPTED
Date: - Permit Number: ���� Q�thJ
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Building Permit Application F JA�2g �f ��.y
Planning and Development Services est/@/q9
Building and Code Regulation Division 4�%oPpa /
2300 Virginia Avenue, Fort Pierce FL 34982 cO4o�y 0/1 Oe/�
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential V
PERMIT APPLICATION FOR: Roof
PROPOSED IMPROVEMENT LOCATION:
-
Address: Le?_4t «flC) RA n, T(Prc Q
Legal Description: 13 50 gq CA 5Vv r SWIG N t
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PropertyTax ID #:10 - (���L1���)�S Lot No.
Site Plan Name: NIA Block No.
Project Name: NIA
Setbacks Front NIA Back: N/A Right Side: NIA Left Side:, NIA
DETAILED DESCRIPTION OF WORK:
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INFORMATION:
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E1HVAC Gas Tank ❑Gas Piping _ Shutters 00Windows/Doors
Pta
Eectric 0Plumbing ❑Sprinklers Generator LJ Roof Z Roof pitch
Vz/TSq. Ft of Construction: 1 VAwl'g)< W Flak S Ft. of First Floor: N/A )Z
Cost of Construction: $ 'I . Utilities:CnSewer ElSeptic Building Height: NIA
OWNER/LESSEE:
CONTRACTOR:
Name - �
Name: Christopher Collins
Address:Let
Company: Collins Roofing Inc.
City: i-�t. vxzrce State: F(c
Zip Code: �J '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 required.
J,
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _Not Applicable
Name:
MORTGAGE COMPANY: IrNotApplicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: FL Pierce State:
Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ Not Applicable
Name:
BONDING COMPANY: Not Applicable
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 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 ing rmit applications are exempt from undergoing a full concurrency review: roo additions,
accessory ctures, swi Vin ools, fe es, walls, signs, screen rooms and a o es t other n -residential use
WARRR NG TO OWN .Your failure t Record a Notice of Com neement m result in your eying twice for
im ovements property. A N tice of Commencrt must be o ded and ost d on the jobsite
b ore the fir p coon. If u in nd to obtain financonsult Ider att rney before
ommenci r or recor n r Notice of Comm ent.
igna re of w er/ Lessee o actor as Agent for Owner Si a of Contr or/License Holder
STATE OF FLORIDA 1 STATE OF FLO,R� A
COUNTY OF -S4 kCtCi a COUNTY OF J�
The forgot . ng instrument was acknowledged before me
thisdayof�ScIiivary 20LI by
Name of person making statement
Personally Knowny OR Produced Identification
Type of Identification
Produced ^ o
(Signat re of Notary Public- State of Florida )
The forgoing instrument was acknowledged before me
this I:2 day of C SGy )( tLl rt� 20M by
Name of person making statement
Personally Known OR Produced Identification
Type of Identification
Produced
(Signature of Notary Public- State ofFlorida )
Commission No. o<� I) DINAHGCUSHMAN Co ission No.
�� 11" Notary Public -State ofF1 Ida
ZONING
REVIEWS FRONT EGETATI
I COUNTER I REVIEW SUPERVISOR
I- REVIEW I V EVIEWON
RECEIVED
Rev. 8/2/17
SM)H G CUSHMAN
Rotary Public - State of Florida
Commission 0 GG076851
MvComm. Wires Feb 28, 2021
REVIEW I REVIEW