HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COf`U. `iTED FOR APPLICATION TO BE ACCEPTE'ri
Date: L2,191 Permit Number: J q
RECEIVED-
•
ilit- - _ Building Permit Applicatio i JAN 2 8 2019
Planning and Development Services ST. Lucie County, Perm
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential x
PERMITTYPE: ROOF BY
PROPOSED INPROVEMENT LOCATION: , Laule Cum Ity—
Address: 10725 S. Ocean Dr#262 Jensen Beach, FL
Property Tax ID #: 4511-501-0144-000-0
Site Plan Name:
Project Name: Douglass House
DETAILED DESCRIPTION OFWORK:
Remove existing shingle roof and install new metal roof
Lot No. 27
Block No. D
CONSTRUCTION INFORMATION: I I t
Additional work to be performed under this permit— check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters -Windows/Doors
_ Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction: 1100
Cost of Construction: $ 6100
Generator Roof 3/12 Pitch
Sq. Ft. of First Floor:
Utilities: _ Sewer _ Septic Building Height: 8 ft
OWNER/LESSEE:
CONTRACTOR:
Name Roger & Patricia Douglass
Name: Jamie Cisco
Address. 8 Triton Ct
Company: Sunshine Roofing LLC
City: Fairport State: IVV
Zip Code: 14450 Fax:
Phone No.607-769-3231
Address: PO Box 1083
City: Palm City State: FL
Zip Code: 34991 Fax:
Phone No 772-260-8195
E-Mail: phdouglassl957@gmail.com
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail sunshineroofingllc@gmail.com
State or County License CCC1327796
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
If value of HVAC Is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTALCONSTRUCI N LIEN,LAW INFORMATION-
DESIGNER/ENGINEER:, _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: _Not Applicable
Name:
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
commencing work or recording vour Notice of Commencement.
iJ /
/ r f-. L t-. I '�) eta (b,A I
Y
Signature of Owner/ Lessee/Contrabor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORI
STATE OF FLORIDA
COUNTY OF 3 CrC/L
COUNTY OF�L LuCi e
The forgoing instrument was acknowledge before me
The for oing instrument was acknowledgej before me
`,Aday
this day of S n t�Gr 20 by
this of t�G- 20JL by
6cG \`, Cro si In SS
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 [denfq ation
Type of Identification
Produced /Mons—_
�FProduced
r" I�
(Signat ire of Not r P blic State of lorida)
(Sig ature of N tary Pub c- State f Florida )
Commission No. (Seal)
Commission No. (Seal)
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Rev. 9 26 1$ L
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, Marityn Kluegel L%TydiF
Madlyn Kluegel
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