HomeMy WebLinkAboutROOF PERMIT APPLICATIONDATE: FEES DU
Permit #:
C Planning & Development Services Department
Building & Code Regulation Division
• R J . A 2300Virginia Avenue
Ft. Pierce, FL 34982-5652
_ _ Te1.772-062-1553
APPLICATION FOR ROOF PERMIT
SEE REVERSE IDE FOR INSTRUCTIONS
1. Location/Site Address: b q b )i1; n nn.Eu101 C,
2. Parcel ID Number: - $ I] - 6U1� - DOD .
is
�r cgtiti
lG�� BY FO
Office Use
hip
I Range
I Ma Pa a
Zoning
I Land Use
Initials
Only
3. Description of Projector Work Activity:
4. Total Roof Area (square feet): 3, d M 5. Roof Pitch: 1 d�
6. Type of Roof: [Fiberglass Shingle [ ] Concrete Roof Tile [ ] Wood Shake / Shingle
[ ] Tar & Gravel [ ] Modified Bitumen [t4 Other r. / afne,
[ ]Product Approval required for all types of Roofing Material (2 Sets)
[ ] All Commercial Roofing requires design by an Engineer or Architect (2 Sets) with Product
Approval attached
** Roof Mitigation per F.S. 553.844 will be required.
Owner Information 8. Contractor Information
Name: &Ab e l 11� i �In 11
Add
re LrST-
Le�h,nnoeCity: I61ri State: _
Zip: -:5 4q Prl Phone:
9. Value of Construction: $
FLReg/Cert#: eee /3300M-
County Cert #:
Business Name:
Cell Phone:
"Note Dry -in and Final Inspection Required. Additional inspection may be required per Product Approval
CONTRACTOR/OWNER'S AFFIDAVIT. I certify that all of the information contained in this application is correct and that all work will be
done in comp ' r all a i le In gulating construction and zoning.
F 46wx
PRINT QTJALIFIFRS/0W#E1t&NAh# SIGNATURE OF QUALIF—EEIVQV9WoW
STATE OF FLORIDA,
ACKNOWLEDGED BEFORE ME THIS DAYOF1JAAt Y) 20—ft,
ISI
ISPERSONALL KNO 1T0 ME OR HAS PRODUCEDN URE OF NOTARY TYPE PRINT NAME OF NOTARY
iI �l• M.M. 4 _AIII
MARGUERITE M. ESTOCK
MT' COhAUSSION Y FF236195
EXPIRES: October 5, 2019
Bonded Thm NONryPubde Undemde,
NOTICE TO OWNER: FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE
FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT YOUR LENDER OR
ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
Revised 426/2010