HomeMy WebLinkAboutApplication for Roof PermitDATE:. I D'1_�I FEES DUE: I RECEIPT #: I Permit #: /,��'n� • b / Y `7.
S Planning & Development Services Department
Building & Code Regulation Division
2300 Virginia Avenue
.��+.v,.da.diwl.✓o1.er..finw.5pl.,an Ft. Pierce, FL 34982-5652
Tel. 772462-1553
APPLICATION FOR ROOF PERMIT
E SIM�NRUCTION
p rU1. Location/Site Address: -OrI TlbOSE4
2. Parcel ID Number: 3 — rJOQ 5-- Com- LJ
Office Use i Section Township Range I Map Page I Zoning I Land Use Initials
Only
3. Description of Projector Work Activity: 4 t fw -an f
4. Total Roof Area (square feet): 5. Roiitch: 4 kP
At -
6.
Type of Roof. Fiberglass Shingle [ ] Concrete Roof Tile [ ] Wood Shake / Shingl
[ ] Tar & Gravel [,4 -Modified Bitumen [ ] Other
f V] 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
**_Rdof Mitigation per F.S. 553.844 will be required.
7. Owner Information 8. Contractor Information
Name:�I�{'` Lr/.y1 /Vt {�vv [P FL Reg/Cert #: (CC [ 7i ''7
Address:
d(' o �evx qv (e 9 County Cert #:
City: �I� 4 vu State: F-7//��L Business Name: t CY, 0 fi*I/
lii[
Zip: Phone: —7-7 P ;L/L & /3 rj Cell Phone: CII C/ l�
9. Value of Construction: $ i 6CO , °U
"Note Dry -in and Final Inspection Required. Additional inspection may be required per Product Approval.
CONTRACTOR/OWNER'S AFFIDAVIT: I certify thatall of the informs " n contained inhi aPPlication is co=ct and that all work will be
done in compliance pli l ws sting construction and zoning.
�(CtICcS
PRIN'rQ A IFIERS/OWNERS NAME SIGNATURE OF QUKLnrIER/OWNER
STATE OF FLORIDA, COUNTY OF M(i.,l4 i h
ACKNOWLEDGED BEFORE ME THIS i _ DAY OF K.RJ • 20-, BY
WHO S MONALLY KNOWN ' O M AS PRODUCED
'SIGNATTE OF NOTARY EOR PRINT NAME OF NOTARY
COMMISSION NUMBER
NOTICE TO OWNER: FAILURE TO RECORD A NOTICE OF CO!
FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO
ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCI
Rmised 4262010
M
TWICE