HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONd'-
1
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED K7/ `' I��
Date: SCANNED Permit Number: t!/
BY
St. Lucie County
Building Permit Application (�
Planning and Development Services 4196.
Building and Code Regulation Division Pcv�
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: Roof Li
PROPOSED IMPROVEMENT LOCATION:
Address: ILM)n 0ti,E-t4a� P= i Plexjt
Legal Description: 6 36 39 BEG AT INT OF W LI OF SHINN RD AND N RNV OKEE RD. TH NLY ON R1W SHINN RD 250.19 FT, TH SWLY // WITH OKEE RD 208.71 FT,
THS//WITH SHINN RD 250.19 Fr TO PT ON N R/W OKEE RD. TH NELY ON R/W 208.71 FT TO POB-LESS OKEE RD WIDENING AS IN OR 330-1433-(0.60 AC)(OR 19 2632)
Property Tax ID #: 330n6-2111-0005-000-l' Lot No.
Site Plan Name: am Block No.
Project Name: P221
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK: III
Re -roof 52 Squares with Owens Corning Duration Shingles 10674-FC13'
ICONSTRUCTION INFORMATION: III
OHVAC Li Gas Tank
0 Electric 0 Plumbing
Total Sq. Ft of Construction: 5200
Cost of Construction: $ 18000.00
JCI II IIL—LJIMM O11 dpply.
oas Piping Shutters Q Windows/Doors
Sprinklers Generator Roof Roof pitch
S Ft. of First Floor:
Utilities: 11Sewer OSeptic Building Height:
OWNER_ /LESSEE:
CONTRACTOR:
Name
1
Name: L^'ne_' `7 la*rl ryn
Address: la'�14 & t) .S vllf� rnLto
_
Company: My Affordable Roof
City: PS L State: JEL,
ZipCode:MV 3tM10 Fax:
Phone No.772-216-9567
Address: 1585 Kennesaw or
City: CIO yP_jy)0n+- State:FL
Zip Code: 34711 Fax:
Phone No. 772-2474463
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail: `A'endell@myaffordableroof.com
State or County License: CCC1331305
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
_ Not Applicable
MORTGAGE COMPANY:
_ Not Applicable
Name:
Name:
Address:
Address:
City:
State:
City:
State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
_ Not Applicable
BONDING COMPANY:
_Not Applicable
Name:
Name:
Add ress: +5e5 Kennesaw o,
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 ermit 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 property. A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencine work or recordine vour Notice of Commencement.
1—�
Signature of Owner esse_e- ractor as AgenTTor Owner
Signature of Co tractor icense H
STATE OF FLORIDA.�,
STATE OF FLORID&-
COUNTY OF 1—b2T ��
COUNTY OF iC��j
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this day of J" [ . 20L& by
11 A o uh-1 k-
I�
thisj5lbdayof�Jt r N\Q ,�20� by
C m Ls F-�3La r' n
,Z
Name of person making statement
Name of perso making statement
Personally Known � OR Produced Identification
Personally Known � OR Produced Identification
Type of Identificatio
Type of Identification
Produced
Produced
_
(Signature of Notary Public -State of Florida)
(Signature of %o� Put#igbS*EEg),h�rida )
Roberta Bennett
Commission NMIMWKY PUBLIk5eal)
NOTARY PUBLIC
Commission FLORICWeal)
CSTATE OF FLORIDA
a Comm# FF952012
• �'t'eE
Comm# FF952012
`s0 Expires 1/20/2020
cats Expi
s 1/20/2020
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
RE IEWIf
REVIEW
REVIEW
REVIEW
DATE
C e
RECEIVED
G f
DATE
COMPLETED
piG
Rev.8/2/17