HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APP/L�ICA�BL{E �INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Datel( �/ SCANNED Permit Number:
BY
St. Lucie County
MGM
Building Permit Application
p9�i�H fOl
Planning and Development Services ��
Building and Code Regulation Division �'Pi0 �9
2300 Virginia Avenue, Fort Pierce FL 34982
P'�one: (772) 462-1553 _Fax: (772)-462-1578 Commercial ReSiden al b.
Address: 210 NE JARDAIN ROAD, FORT PIERCE
Legal Description: RIVER PARK - UNIT 9 - PART B BLK 73 LOT 19
Property Tax ID #: 3419-565-0025-000-2 Lot No.
Site Plan Name: Block No.
Project Name: SMITH J/REROOF
Setbacks Front Back: Right Side: Left Side:
TEAR OFF SHINGLE, RENAIL DECK. INSTALL NEW JA TAYLOR ROOFING 5V CRIMP ROOF
SYSTEM (FL#17443.1) OVER OWENS CORNING WEATHERLOCK TILE& METAL (FL#9777.7)
SELF -ADHERED UNDERLAYMENT.
HUU I LIUIId I WU I K LU WU el lunneU U11ue1 uus pelnu L—LneLK du apply:
�HVAC Gas Tank ❑Gas Piping _Shutters ❑Windows/Doors
Electric Plumbing []Sprinklers Generator Roof 6/12 Roof pitch
Total Sq. Ft of Construction: 1,900 S Ft. of First Floor: 1.239
Cost of Construction: $ 9,000 Utilities:cnSewer OSeptic Building Height: 1 STORY
(DWNER/,LE'SSEE:
G- NL C R:
Name JEFFREY SMITH
Name: KYLE WHITE
Address: 210 NE JARDAIN RD
Company: J.A. TAYLOR ROOFING INC
City: PORT ST LUCIE State: FL
Zip Code: 34983 Fax:
Phone No. 772-249-6266
Address: 302 MELTON DRIVE
City: FORT PIERCE State: FL
Zip Code: 34982 Fax: 772-468-8397
Phone No. 772-466-4040
E-Mail: ESLENVIRONMENTAL@AOL.COM
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail: NADINE@JATAYLORROOFING.COM
State or County License: CCC1325895
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL �®NSTRUC LON LIEN LAW INF@RMA*
�TTil,0N:
DESIGNER/ENGINEER:
Name:
Not Applicable
MORTGAGE COMPANY:
Name:
of Applicable
Address:
Address:
City:
Zip: Phone
State:
I
City:
Zip: Phone:
State:
FEE SIMPLE TITLEHOLDER:
Name:
_ of Applicable
BONDING COMPANY:
Name:
_ of Applicable
Address:
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 may result in your paying twice for
improvements to your pr erty. Notice of Commencement must be recorded and posted on the jobsite
before the first inspe n. If yo Intend to obtain financing, consult with lender an ttorney before
commencing work,recordin your Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF STLucIE
COUNTYOF STWCIE
The forgoing instrument was acknowledge efore me
The forgoing instrument was acknowledge before me
this 27TH day of SEPTEMBER 20by
YFIIs P7TH day of SEPTEMBER 2O by
KYLE WHITE
KYLE WHITE
Name of person making statement
Name of person making statement
Personally Known xx OR Produced Identification
Personally Known xx OR Produced Identification
Type of Identification
Type of Identification
Produced
'RFSq'`✓�y
Produced
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_ (Signature of Notary Public- State of F[Srida`�eN
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FF936050 �*Seal ) ;FF 93u050 : o¢
Commission No. �
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"Commission No. FF s3so5o � `{Seal�:F 935050
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REVIEWS
FRONT
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SUPERVISOR
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VEGETATION
SEATURTLE
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REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17