HomeMy WebLinkAboutAPPLICATION FOR ROOF PERMIT1
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DATE: FEES DUE: RECEIPT #: Permit #:
Planning & Development Services Department
p Building& Code Regulation Division RECEIVED
• 0 2300 Virginia Avenue
Ft. Pierce, FL 34992-5652
Tel. 772462-1553 MAR'SMED
APPLICATION FOR ROOF PERMIT PERMIT-rAY
SEE REV�E SIOR IN$ifjUCTIONS
1. Location/Site Address: ""��"''' qA Srr /'i/nr�, I,t �• l/7J[I)� St. Lu9h�,n,�'�,,�Unt
2. Parcel ID Number: _449 0o01 —w 5
Oftice Use
Only
Section
Townshi
Rnn e
Ma Pa a
ZoniD
Land Use
Initials
Z
-
3. Description of Project or Work Activity:
II
4. Total Roof Area (square feet): / 00 v�5. Roof Pitch: .- /Z V
6. Type of Roof: [ ] Fiberglass Shingle [AConcrete Roof Ti 299
1� [ ]Wood Shake /Shingle
[ ] Tar & Gravel [ ] Modified Bitumen [ ] Other & P y%q<
[ ] 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 Informatiofn� n 8. Contractor Information
n rc Name:b;c D-P Yarn
Addrgs}s:
City i!J State: 33 0 -�(�Sa
Zip: Phone: ���� ! •'t)
9. Value of Construction: $ 9e, 4A11
FL Reg/Cert#: l('11. 31 SgDB
County Cert #: pgS�'j
Business Name: .&C ICDU �
Cell Phone:
"Note Dry -in and Final Inspection Required. Additional inspection may be required per Product Approval.
CONTRACTOR/OWNER'S AFFIDAVIT: I certify that all of the information contained in this application is corect and that all work will be
/ 1 ( done in compliatir with all agpl`cable I��egulating construction and zoning.
.......1........ .....o..,..i.n as ivxmn Slt:�l'A�ITItE OF QUALIFIEWOWNER
STATE OF FLORIDA, COUNTY OF//
ACKNOWLEDGED BEFORE ME THIS 4M DAY OF ZO�C BY
O IS PERSONALL OWN TO ME OR PRODUCED--� Pudk State of Florida
T 'wile M Ealodt
JE
My Commission ESIoa96a
SIGN lzC OF NOTARY PRINT NAME OF NOTARY (seal a tiv' Eapless 101 5=16
CO I 'ION NUMBER I=F_ J •�
NOTICE TO OWNER: . FAILURE TO RECORD A NOTICE OF COMMENCEMENT M,pt BF:SULT IN YOUR PAYING TWICE
FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANC1NGt„ "f$R
,S, L YOUR LENDER OR
ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. '�
Revised 4262010 MgR3
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