HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABL7 INF MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ' t�
Date: Permit Number: I G S b
RFCFIVFQ SCANNED
BY
Building Permit Application Pe Mgyo810�9 St. Lucie Count
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Planning and Development Services St. L n90Pp
Build
ng and
ode Regulation
ivision
2300Virginia /CAvenue, Fort Pierce FL 34982 ce �0vnry ent
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: Roof
PROPOSED IMPROVEMENT LOCATION: — ~"
Address:
Legal Description:
U/V77 OS eu� L LDT 17
Property Tax ID#: 3yo2 Lo09 0075- Lot No.
Site Plan Name: N/A Block No.
Project Name: N/A
Setbacks Front N/A Back: N/A Right Side: N/A -Left-Side- N/A
DETAILED DESCRIPTION OF WORK: `
SFC
CONSTRUCTION INFORMATION:
L JHVAC "Gas Tank UGasPiping
11 Electric El Plumbing ❑Sprint
Total Sq. Ft of Construction: 0�500
Cost of Construction: $ / Z 000100
Shutters ❑Windows)/�D—�o-/o-/rrsss
I_ Generator E Roof � Roof pitch
S�Ftj of First Floor: N/A
Utilities: Sewer 0 Septic
Building Height: N/A
OWNER LESSEE:
CONTRACTOR:
Name T I
Name: Christopher Collins
Address: 400ryy 6/9"2f7e
Company: Collins Roofing Inc.
City: �� A_z E �% State: q
Zip Code: I�J �P �. Fax: N/A
Phone No. N/A
Address: P.O. Box 12867
City: Ft. Pierce State: FL
Zip Code: 34979 Fax: 772-489-6505
Phone No. 772-201-1352
E-Mail: N/A
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail: collinsroofinginc@gmail.com
State or County License: CCC-058011
If value of construction is $2500 or more, a RECORDED Notice of Commencement is regwrea.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: Ft. Pierce State:
Zip: Phone:
FEE SIMPLE TITLEHOLDER: VNotApplicable
Name:
BONDING COMPANY: _Not Applicable
Name:
Address: P.O. Box 12867
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 revie • m additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory to anot�ie n-residential use
WARNING T NER: Y r failur Record a otice of Commencem may res in yo a "n twice r
improve is to your o e . A otice of C mmencement must a recor d and - to a jo site
before a first inspe to . I ou in o ain financing, cons t with f� deb or tt f e
comm ncine fvork o r o ine vo o ' f Commencement.
/—/ Ah M
Lessee Agent for Owner
N:
Slgnatur Holder
Sig re tuwner/ on or as
of -ont ctor/License
STATE OF FLORIDA
aI-XA,Afg-
STATE OF FLORIDA
S�wlCt-�—
COUNTYOF
COUNTY OF
The fo going instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this day of 204 by
this _�— day of t 204 by
rr,lA►Ns
Name of person making statement
Name of person ma -king statement
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of IdentificationF—L
Type of Identification
!FL
Produced �i- D
Produced ALL
FUu4G2S
!aI rC-t A �-
(Signature of Notary Public- SYate of Florida)
(Signature of Notary Public -State oyloricla )
616- J700
Commission No. (Seal)
Commission N
u,,,,
VAUGHN
oo.�•oJ;., LEN VAUGHN
=x.: State of Florida -Notary Public
c+°��`04:=State oLLEN
;= Commission # GG 2
-
X`O
mmission # G
ffsion
270079
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REVIEWS
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22,
02
REVIEW
REVIEW
REVIEW
IEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17