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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 64�/ 10R Permit Number: �9 to0- Aw 414121-0 Q-Mm- FRE C E I %FtD�
Building Permit App icationMAY 2 2019
Planning and Development Services Permitting Department
Building and Code Regulation Division g p
2300 Virginia Avenue, Fort Pierce FL 34982 St. Luci•^eYC�Unty, FL
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial t;o,
PERMIT TYPE: RE ROOF
PROPOSED IMPROVEMENT LOCATION:
Address: 2603 BENNETT DRIVE
Property Tax ID #: 1432 807 0021 0000
Site Plan Name:
Project Name: RE ROOF SHINGLE
Lot No.263
Block No.
DETAILED DESCRIPTION OF WORK:
RE ROOF \ ter o�F �9F1 ivv S G �� i.�� rb VMpr\Z
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CONSTRUCTION INFORMATION:
Additional work to be performed under this permit -check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters
_ Electric _ Plumbing _ Sprinklers
_ Generator
Windows/Doors
/Roof !L2, Pitch
Total Sq. Ft of Construction: 2500 Sq. Ft. of First Floor: l�-00
Cost of Construction: $ /LYI Utilities: /Sewer _Septic Building Height: /S)l
OWNER/LESSEE:
CONTRACTOR:
Name RUBY DAVENPORT
Name: TODD ADDERLY
Address:2603 BENNETT DRIVE
Company: ADDERLY DEVELOPMENT INCP
City: FT PIERCE /State:
Zip Code: V;9 % Fax:
Phone No.
Address:5079 N DIXIE HWY # 258
City: OAKLAND PK State: FL
Zip Code: 33334 Fax:
Phone No 954 445 4078
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail addelrlydev@yahoo.com
State or County License CCC 1327886
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.
SUPPLEMENTAL CONSTRUCTION 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 JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
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Signature of Owner/ Lessee oittraCiGFiTs�`Age fbriOAney, r�
Signat of Contractor/Lic s Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF BROWARD
COUNTY OF BROWARD
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this _ day of MAY 1.2019
.20_ by
this_dayof MAY12019 20_
by
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Name of person making statement.
of erson making statement.
Ogry
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Personally Known OR Produced
Identification
POWs ally Known OR Produced Identification
Type of Identification
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of Identification
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Produced
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(Signature of Notary Public -State of Florida) 1•,
(Signature of Notary Public -State of Florid ; y<;r•.
Commission No.
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Commission No.
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REVIEW
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REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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