HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED - ,]
Date: 2-13.2019 Permit Number:
Building Permit Application
Planning and Development Services FEB 13 2019
Building and Code Regulation Division ST. Welt G13UM P9rfi11RMQ
---2300-VirginiaAvenue,,-Fort Pierce FL-34982— _
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residenfial X
PERMIT APPLICATION FOR: Roof — s�w.4\as @lt�- sennlnu=r�
Address: 5705 Paleo Pines Circle Fort Pierce, FI
Legal Description: Holiday Pines S/D PHASE 1 LOT 19
Property Tax I D #: 1312-500-0020-000-2
Site. Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK
Tear off existing shingle roof, Install ASTM 30#.
Install Owens Corning Supreme 3 Tab shingle.FL10674-R13
Tear off existing flat roof, install Elastoflex SAV and Polyglass G FL1654-R23
Lot No.
Block No.
AULULIondi wurK co oe enormea unuer r.rus Perrnu—cnecK du dppry:
❑HVAC _Gas Tank E]GasPiping n Shutters ❑Windows/Doors
❑ Electric Plumbing []Sprinklers ❑ Generator El Roof 4/12 I Roof pitch
Total Sq. Ft of Construction: 3,000 S Ft, of First Floor:
Cost of Construction: $ 14,100.00 Utilities: Sewer ❑Septic Building Height:
OWNER/LESSEEi * y
CONTRACTOR;; t YW
Name Jacqueline Forshay
Name: Christopher A. Long
Address: 5705 Paleo Pines Circle
Company: The Roof Authority, Inc.
City: Fort Pierce, State: FL
Zip Code: 34951 Fax:
Phone No. 914-245-2085
Address: 6771 N. Old Dixie Hwy
City: Fort Pierce State: FL
Zip Code: 34946 Fax:
Phone No. 772-468-7870
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail: tra1993@gmail.com
State or County License: CCC056933
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
S.UPPLEMEMPALCONSTRUCTION',LIEN'LAW INFORMATION:
Ut]I(7NtK/tNGINttK: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable I BONDING COMPANY: _Not Applicable
Name:
Name:_
Address:
Address:
City:
City:_
Zip: Phone:
Zip:
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 W_oH(z0rlttordinR your Notice of Commencement. n
Signat re of Owner/ Lessee/Contractor as Agenf forOwher
Sign of ontractor/License Holder
STATE OF FLORIDA
S TE O FLORIDA
COUNTY OF �e,�c
CO OF T�/_ L tecic
The for o. g instru,uu((��en was acknowledged before me
The fo�r�y.ng instrumen -was acknowledged before me
this f, day of Y r dAi20J_2 by
this//a'""`day of . 20—/2 by
//
ame of person making stateyfient ✓
Name of personyaking stateme t
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced I-_ (_.
Produced
lumodL LJS�di6..
Tw, ?P� w Sw�—
(Signatur of Notary Public -State of Florida I.Imothyvy. Sutton
(Signatur of Notary Public -State of Florida I
r
�TARY PUBLIC
Commission No. �isil>?S 44'z.— : P
Commission No. 4 I YS'�8Z ��r T' othy W. Sutton
� a eTARY PUBLIC
e ❑STATE OF FLORIDA
x Comm# GG785982
r
E OF FLORID
r a 22
= CommiF GG185982
'dlM1 J%I'bExpires
3120/202
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
I
COMPLETED
`
Rev.8/2/17