HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �i !� "� f Permit Number:
Permittin9 Department
Building Permit Application Lucie County
St.
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Residential
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial
PERMIT APPLICATION FOR: Roof
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Address: 7/ -% c5l/UtE�C COE AW,
Legal Description: 11411)14,41 U/�.P FaT�
U.yrr O 5- .�/ 2 y L07:5 �frr y°i
PropertyTax ID #:2yp% &,04- 61142 Lot No.
Site Plan Name: N/A Block No.
Project Name: N/A
Setbacks Front N/A Back: N/A Right Side: N/A LeftSide: N/A
DETAILED
D�SCRIPTION`QF WORK " a x '`
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3y00 5F VIEW
/o Y 7/9-L
_. � _
itiona wor to je�e orme un ert iepermit—c ec a appy:
❑HVAC LJ Gas Tank ❑Gas Piping _Shutters ❑ Windows/D rs
❑Electric ❑ Plumbin�g/22 ❑Sprinklers ❑Generator Roof �� _
TotakSq: F.tof Construction: / J d� 5 Ft. of First Floor. N/A
❑Septic
C6st of Construction-$ _ 000` ®CJ Utilities: _Sewer Building Height: N/A
OWNER%LESSEE„
CONTRACTOR F s x 's r
,..
Name !�
Name: Christopher Collins
Address::2_/ G1 lied tWC
Company: Collins Roofing Inc.
City: 4&�.���.eL� State:�L_
Address: P.O. Box 12867
City: Ft. Pierce State: FL
Zip Code:�Fax: N/A
Phone No. N/A
Zip Code: 34979 Fax: 772-489-6505
E-Mail: N/A
Phone No. 772-201-1352
Fill in fee simple Title Holder an next page (if different
E-Mail: collinsroofinginc@gmail.com
State or County License: CCC-058011
from the Owner listed above)
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
Address:
City: State:
Zip: Phone
City: Ft. Pierce
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY:
Name:
_Not Applicable
Address• P.O. Box 128e7
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 ma3LresuIt in your a n twice for
improvements to your property. A Notice of Commencement must co and ed on a jobsite
before the first inspection. If you intend to obtain financing, cons with n an n fore
Nln+irn of r-nmmonromont A
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Signature of Own Lessee/ n act s 0 ner
ign tur Contractor/License o der
STATE OF FL RIDA
STATE OF FLORIDA
COUNTY OF
-COUNTY OF
7 L� f-car
The forgoing i stru nt was acknowledged before me
The forgoing instrument was acknowledged before me
this day of n.rN 20-4 by
this Y day o mw� 20L!E) by
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C: h ask rc,[ 6
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LO�C'n
Name of person making statement
Name of person making statement
Personally Known OR Produced Identification
Personally Known
OR Produced Identification
Type of Identification
Type of Identification
�Z—
Produced E" L— o L
ProducedL
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(Signature of Notary Pub ic- State of Florida)
(Signature of Nota
ate of Florida )
Commission No. """ . ELLEI�6 GHN
ELLS
Commission No. ;� .e of Floritlf=Na13HN
•:°�i State of Floritla-Notary Public
Commission # GG 270079
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g Commf®elfin q y Public
My ptlmmiaaIonEx'9a7e
,�;.• My Commission Expires
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REVIEWS
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PLANS
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SEA TURTLE
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COUNTER
REVIEW
REVIEW
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REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17