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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED + //��
Date: SCANNED Permit Number: _IVIOt0-0IS3
e, St. Luce County (RECEIVED
Building Permit Application JUN U 7 2016
Planning and Development Services PERMITTING
Building and Code Regulation Division St. Lucie County, FL
2300 Virginia Avenue, Fort Pierce FL 34981
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial X Residential
PERMIT APPLICATION FOR: Roof
PROPOSED IMPROVEMENT LOCATION ;-;
Address: 3455 N US HWY 1
Legal Description: 28 38 40 THAT PART OF S 565.45 FT OF N 1283.95 FT OF E 1/2 OF NW 1/4 LYG W OF US 1 -
LESS N 20 FT - BEING PART OF GOVT LOT 2
Property Tax ID #: 1428-210-0015-000-0
Site Plan Name:
Project Name: RELAX INN / REROOF
Setbacks Front Back:
DETAILED DESCRIPTION OF WORK:
Right Side: Left Side:
Lot No.
Block No.
TEAR OFF SHINGLES. RE -NAIL DECK. INSTALL OWENS CORNING OAKRIDGE SHINGLE
ROOF SYSTEM OVER OWENS CORNING WEATHERLOCK G UNDERLAYMENT.
(41 SQ / 3/12 PITCH).
CONSTRUCTION'INFORMATION;
• u11UG1 LI IO FICI I IIIL — LI ICLR tlll OpFlly.
OHVAC Gas Tank ❑Gas Piping _Shutters ❑Windows/Doors
Electric 0 Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: 4100 S . Ft. of First Floor: 4349
Cost of Construction: $ 11,900.00 Utilities:Sewer Septic Building Height: 1 STORY
OW N ER/LESSEE
CONTRACTOR:
Name GP HOSPITALITY INC
Name: KYLE WHITE
Address: 3455 N US HIGHWAY 1
Company: J.A. TAYLOR ROOFING INC
City: FORT PIERCE State: FL
Zip Code: 34946 Fax:
Phone No. 631-879-3477
Address: 302 MELTON DR
City: FORT PIERCE State: FL
Zip Code: 34982 Fax: 772-468-8397
Phone No. 772-466-4040
E-Mail: DIPAKDAVE24@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
a value aT construcuon is pebuu or more, a ittcoicoeo Notice of Commencement is required.
SLIPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION::
DESIGNER/ENGINEER: x Not Applicable
Name:
MORTGAGE COMPANY: x Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: x Not Applicable
Name:
BONDING COMPANY: x Not Applicable
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
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 yjWr property. A Notice of Commencement must be reccordeo and posted on the jobsite
before the fir Ins ction. If you intend to obtain financing, consult wit or an attorney before
_ Signature of Owner/ Lessee/Agent
STATE OF FLORIDA f Il STATE OF FLORIDA 1
COUNTY OF�1. Ut✓�-Q� COUNTY OF
The forgoing instrument was a knowledged before me The forgoing instrument was acknowledge before me
this � day of T 20 t[Qby this a`pay of aV 20 jQ by
KYLE WHITE KYLE WHITE
(Name of person acknowledging) (Name of person acknowledging
Notary Public- State of Florida I (Signature of Notary Public- State of Florida )
Personally Known L,""�OR Produced Ict�pSNl}f�tlflfll�_
Type of Identification Produced �� p\v -
`� •�1SSION �i
Commission No.�F47 (3t9},m�efrs2ehO9:
o
Revised 07/15/2014
Personally Known �� R Produced
Type of Identification Produced
Commission No1f-tl--lLt9� 0
0
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