HomeMy WebLinkAboutROOF PERMIT APPLICATIONOffice Use Only I Master #
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Date: D' x3 6
1. Location/Site Address:
St. Lucie County Building & Zoning
2300 Virginia Avenue Ft. Pierce. FL 34982-5652
Tel. 772-462-1553
APPLICATION FOR ROOF PERMIT
SEE REVERSE SIDE FOR INSTRUCTIONS
SCANNED
St. LudeCouofv
2. ParcelIDNumber:3.)\I-S1i-Goln-000-p
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Office Use
Section
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Land Use
Initials
Only
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3. Description of Projector Work Activity: Am.!!AC \\ ROOF
Engineering required for Rigid Tile roof coverings per FBC 1507.4 & 1606.3.3
Engineering required for Metal Roof Panels
4. Total Roof Area (square feet): 5 \O Q 5. Roof Pitch: 5 I l Z
6. Type of Roof- [ ] Fiberglass Shingle [ ] Barrel/Tile Ceramic [ ] Wood Shake Shingle
[ ] Tar & Gravel [ ] Modified Bitumen [ tOther (specify) Mz-141
7. Owner Information
Name:
Address: 59 �' ��%00d It %J`\\ ,eAN It
City: C, \ \tJt— -"State: 1�) _
Zip: 3 y rt $1 Phone: Li6 4 _ 14 xS
9. Value of Construction: $ �1- 1 1. rC 3 S ao
Note Dry -in and Final Inspection Required
8. Contractor Information
FL Reg/Cert #: GCC \3�.s%ZO
County Cert#: 2oi Q g
Business Name: 2.\?N �,A 4 toe go;:iL
Fees Due:
Receipt #
OWNER'S AFFIDAVIT: I certify that all of the information contained in this application is cUREOF
work will be done in compliance
with all applicable laws regulating construction and zoning.
G�4d
PRINT QUALIFIERS/OW�RS NAME SIGNALIFIER/OWNER
STATE OF FLORIDA, COUNTY OF t' 4CS� CN
ACKNOWLEDGED BEFORE ME THIS —a*_ DAY OF 20, BY
W WHO IS PERSONALLY KNOWN TO ME OR WHO HAS
PRODUCED (� AS IDENTIFICATIOjN.
GG0T Ra R. Khgeton
SIGNAT OF NOTARY TYPE OR T NAME O NO ARY ' MK_Qe fijMaeton DD2esese
TITLE: NOTARY PUBLIC COMMISSION NUMBER Q bAci6a?, a E*MS Nove nW 09. 2097
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. EXEMPT: A/C -
HEAT REPLACEMENT WITH CONTRACT UNDER $5,000.
St. Lucie County Roof Permit Application