HomeMy WebLinkAboutROOF PERMITDATE: FEES DUE: I RECEIPT #: Permit #:
No
Planning & Development Services Department
Building & Code Regulation Division SCF�NNEU
9. 2300 Virginia Avenue p!/
Ft. Pierce, FL 34982-5652 B
Tel. 772462-1553 .St. Lucie Count,
APPLICATION FOR ROOF PERMIT
SEER VERSE SIDE FOR Ipy��TRUCTIONS
1. Location/Site Address: .571i l F.
2. Parcel ID Number: 1 �l 7 - X41' Q ZOZ' (yoo. /a
Office Use
Only
I Section
Townshi
Range
Map Page
Zoning
Land Use
Initials
3. Description of Projector Work Activity: I nglej (`-yo - I ncl d e E i
4. Total Roof Area (square feet): 4 2W 5. Roof Pitch: [p : Ilk
6. Type of Roof- [Fiberglass Shingle [ ] Concrete Roof Tile [ ] Wood Shake / Shingle
[ ltl
] Tar (;ravel [Modified Bitumen [ ] Other
L0
[ ] 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
** Roof Mitigation per F.S. 553.844 will be required
Owner Information) I S.
Name:
Address: 6III ,.. -.— 6 _5 C.�✓/,I/
City: State:
Zip: Phone: _/�/
9. Value of Construction: $ iT 7
Contractor Information
FL Reg/Cert #: r(, C
County Cert #: 210 /?
Business Name:/
-Gall Phone:
**Note Dry -in and Final Inspection Required. Additional inspection may be required per Product Approval.
CONTRACTOR/OWNER'S AFFIDAVIT: I certify that all oft e all, anon contained in this application is correct and that all work will be
done in complian id II applicable laws regulating construction and zoning.
/, 4.l%Il'+e
P IN ALIFIERS/OWNERS NAME MGNATU1&!bFi7UALIFIER1OWNER
STATE OF FLORIDA, COUNTY OF�_
ACKNOWLEDGED BEFORE ME TH DAY OF k.204—)—, BY
Z
SONA LY OWN TO OR HAS PRODUCED AS IDENTIFICATION
tYPiIBLIC-STATE OF FLORIDA
t3�1 a p.
�r�K�� ar.en S. Nielsen
E O NOTARY`TYPE OR PRINT NAME O NOTARY . eNI17NSs10n #DD1000358
COMMISSION NUMBER U 1 )Jf7/ r_l,_l_J/1 Bo xpir :_J E 12, 2U1g
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 4/26/2010
07/11/2012 14:52 772469R?97 JA TAYLOR ROOF?Nr PAGE 02/05
RATE: •%(j_/Z FEESAUE: RECEIPT#: Permits: 007-Q
1.
3.
4.
6.
Planning & Development Services Department
Building & Code Regulation Division
2300 Virginia Avenue
FL Pierce, FL 34982-5652
Tel. 772-462-1553 SCANNED
APPLICATION FOR ROOF PERMIT �q BY
SEER ERSE SIDE FOR TIATAVCTIONS o�. O tilde r'nllnbt
Location/Site Address: _�111 F. .ii(� 1i�1� 1 p0i r v `Ul `I 1
Parcel ID Number:
Office Use
Section
Township
Range
I Map Page
I ZoningLand
Use
Inidals
Only
113
35"'
xI
I 13 13 �
I 125-'
Iu
Description of Projector Work Activity:—JIP,&j=�)FP A5h; I r1di e i- i
Total Roof Area (square feet): 42_ 5, Roof Pitch. --CO: 12, T, EW
Type of Roof: [aFiberglass Shingle [ J Concrete Roof Tile [ J Wood Shake / Shingle
IP
[ ] Tai& Gravel [dModi�d Bitumen [ ] Other
[ ] Product Approval required for all types of Roofing Material (2 Sets)
J All Commercial Roofing 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
Name:
Address: "D I i ,A.. 1—,(!ht) t i ne% LLIV
City: dYr'F_ State: _
Zip: �; LQ�� Phone:
9. Value of Construction: $
8. Contractor Inform�a�tion
FL Reg/Cert #•
County Cert #:1
Business Name:/T�nrt2gl
� Phone: '7 ' A14IVin
**Note Dry -in and Final inspection Required. Additional inspection may be required per Product Approval
CONTRACTOR/OWNER'S AFFIDAVIT: l certify that aU oC�}J� inC ration contained in dtis application is correct and that all work will be
done in compliant"Avit1 11 applicable laws regulating construction and zoning.
7�F� ,
P iN7 ALIF7eRS/OWNERS NAME sIGNATU F iluAmFirwowNvit
STATE OF F'LORIDA, COUNTY OF4 1 c)(7jr-._
ACKNOWLEDGED BEFORE bM XIIIS UAY OF 204_-A_, nY_ .
W
HOPE SOMA LY OWN TO ME OR HAS PRODUCED S IDENI'1FICA170N
e¢-�, fOTA,RPP[t8t7C-STAILOFFLURtll(1
TYPE OR PRINT NAME O f68Fen 8. Nielsen
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.
Reviled 4/262010