HomeMy WebLinkAboutROOF PERMIT APPLICATIONDATE: 3- 1 - 101 I FEES
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1. Location/Site Address:
Planning & Development Services Department
Building & Code Regulation Division
2300 Virginia Avenue
Ft. Pierce, FL 34982-5652 SCANNED
Tel. 772-462-1553 BY
APPLICATION FOR ROOF PERMIT StLucie County no. i 11l . eoun SEE REVERSE SIDE FOR INSTRUCTIONS y
2. Parcel ID Number: _-13All Q/1- 001q - U D -3
Office Use
Section
Townshi
Ran a
Ma Pa a
Zonin
Land Use
Initials
Only
3. Description of Projector Work Activity:
4. Total Roof Area (square11 feet):pbb 5. RDof Pitch• 6'• / 0IN
6. Type of Roof. [k] Fiberglass Shingle [ ] Concrete Roof Tile [ ] Wood Shake / Shingle
[ ] Tar & Gravel [ ] Modified Bitumen [ ] Other
[ ] Product Approval required for all types of Roofing Material (2 Sets)
[ ] All Commercial Rooting requires design by an Engineer or Architect (2 Sets) with Product
Approval attached
** Roof Mitigation per F.S. 553.844 will be required
7. Owner Information g,
Name: 1 —)ia ' i m d"
Address: '55q S� (cittoM 6ne,
City: rT > .kirit State:
Zip:'] Phone:
9. Value of Construction: S
Contractor Information
FL Reg/Cert#: ACC
County Cert #:
Business Name: eP
Cell Phone: 7d }i l3 ion.
**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 incomplia�allaws regulating construction and zoning.
PRINT QUALIFIERS/OWNERS NAME ``,, 11 SIGNATURE OF QUALIFIERIOWNER
STATE OFFLORIDA, COUNTY OFJ Yt.I(u-(1 00e't.
ACKNOWLEDGED BEFORE ME THIS DAY OF 20.19, By S lg b 1 So
O IS PERSONAL KN I�,To ME OR
a /
SI URE OF NOTAR 7
COMMISSION NUMBER
IDENTIFICATION
MARGUERREM. ESR10X
MYOOMMISSION I FF238195
EXPIRES: October 5, 2019
8Wd&d ThN N.tmm,&r. u.._____
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 4262010