HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONN
ALL APPLICABLE INFO Perm `
UST BE COMPLETED FOR APPLICATION TO B PCm t Number: ` v � �O
Date: 1^Q
RECEIVED
Building Permit Application
Planning and Development Services FEB 19 2019
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 ST. -Lucie County, Permitting
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential xxxxx
PERMIT APPLICATION FOR: Roof SCANNED III
Address: 2421 Atlantic Beach BLVD Hutchinson Island, FL 34949
Legal Description: FORT PIERCE SHORES -UNIT 1- ELK 3S 27 FT OF LOT 14 AND ALL LOT 15 ANDN 1/2 OF
VAC CAVIO RD ADJ ON S (OR 331-1412: 501-2119: 4058-326)
Property Tax ID #: 1436-601-0063-000-6 Lot No.
Site Plan Name: Herman R Summerlin Jr Block No.
Project Name: Herman R Summerlin Jr reroof
Setbacks Front Back: Right Side:
Left Side:
DETAILED I) SCRIPTION OMORK."
Remove and replace existing roof Ckr 0-C
g h�(1�i le,
(-C CL&-
�_he)CACA
LIHVAC Gas Tank
❑Electric ❑ Plumbing
Total Sq. Ft of Construction: 1953.0
Cost of Construction: $ 15,700.00
uuo Nci IlL—uicLn au dpply.
❑Gas Piping _Shutters
[]Sprinklers ❑Generator
S Ft. of First Floor: _
Utilities: Sewer ❑ Septic
❑ Windows/Doors
W1Roof 3/12 .Roof pitch
Building Height: 15
OWNER/LESSEE: `, �'�
GONTRAGTOR:
Name Herman R Summedin Jr
Name: Bryon Keith McStoots
Address:2421 Atlantic Beach BLVD
Company: PetersenDean Roofing & Solar
City: Hutchinson Island, State: FL
Zip Code: 34949 Fax:
Phone No.772-332-8492
Address: 1011 Fairfield Drive
City: West Palm Beach State: FL
Zip Code: 33407 Fax: 561-881-0699
Phone No. 561-881-0660
E-Mail: summel216@yahoo.com
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail: klsmith@petersendean.com
State or County License: CCC1329081
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
It
CONSTRLtCT10NINAVif iNFOEMATION
�SUPPLEIVItUTAI
DESIGNER/ENGINEER:
_ Not Applicable
MORTGAGE COMPANY:
_ Not Applicable
Name:
Name:
Address:
Address:
City:
State:
City:
State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLEHOLDER:
Not Applicable
BONDING COMPANY:
Applicable
Name:
Name:
_Not
Address: toil Fairfield Drive
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 vourNotice of Commencement.
igna�wn2r essee:.•.�rvorasAgentforowner
Signatur Co ctor/License
STATE OF FLORIDA
STATE OF FLORIDA
/
COUNTY OFGir2
COUNTY OF ri�zinr
The forggin nstru nt was acknowledged before me
The forgoiryg instrum t
was acknowledged�efore me
this X y of 20L by
this J/ c ay of , 201by
ame f person
aking statement
Name of'person making statement
Personally Known OR Produced Identification
Personally Known
OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature of Ncffary Pu liN`i; � of Florid§�TH WAGNER
(Signature of Notary Pu
tate of FloridagETH WAGNER
MY COMMISSION k GG 081027
llio-
,„Y COMMISSION p GG 001027
Commission No. �• .� •°o E Qi ApriI13,2021
•••.;
Commission No.
F�IRBQApol13,2021
drft' Bd Th anderu Notary Public Undemdtem
Bonded Thor Notary Public Undorn'drem
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Rev.8/2/17