HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �) D
Date: / %' �'/ scr-,NNED Permit Num e
St. Lucie Cr+,
Building Permit Applicatio BAN 0 9 2ot9
Planning and Development Services Permitting Department
Building and Code Regulation Division St. Lucie Count FL
2300 Virginia Avenue, Fort Pierce FL 34982 Yr
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: Roof
PROPOSED IMPROVEMENT LOCATION:;
Address: 3455 N US HIGHWAY 1, FORT PIERCE
Legal Description: 28 34 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 Lot No.
Site Plan Name:
Project Name: RELAX INN/REROOF
Setbacks Front Back:
DETAILED DESCRIPTION -OF WORK'; --
Right Side: Left Side:
Block No.
TEAR OFF TAR & GRAVEL, ON BUILDING 1 FLAT SECTION,RE-NAIL DECK. INSTALL NEW
POLYGLASS MODIFIED BITUMEN ROOF SYSTEM (W-170).
CONSTRUCTION INFORMATION:'_rk
11HVAC Gas Tank
11 Electric 0 Plumbing
Total Sq. Ft of Construction: 2,200
Cost of Construction: $ 10,000
•
UGas Piping
Sprinklers
Shutters ❑ Windows/Doors
Generator Z Roof 0/12 Roof pitch
S Ft. of First Floor: 3,216
Utilities:�SewerE]Septic Building Height:
1 STORY
"OW,NER%LESSEE
CONTRACTOR
Name GP HOSPITALITY
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 DRIVE
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@JATAYLORROOF]NG.COM
State or County License: CCC1325895
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:;
DESIGNER/ENGINEER: _ of Applicable
Name:
MORTGAGE COMPANY: _�N t Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ of Applicable
Name:
BONDING COMPANY: _ of Applicable
Name:
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'@pplications 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 pro erty. A Notice of Commencement must be recorded and posted on the jobsite
before the first inspe . If you intend to obtain financing, consult with lender or a��Ey�rney before
commencing w r re o ding your Notice of Commencement. `� //
Sign ure o Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Rolder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF STLUCIE
COUNTY OF STLUCIE
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this 8TH day of JANUARY 2D by
this aTH day of JANUARY 20�1 � by
KYLE WHITE
KYLE WHITE
Name of person making statement
Personally Known xx OR Produced Ic��t+'ZV 1j> lalllZ
Name of person making statement
Personally Known xx OR Produced Identification
Type `J\�\C�4......... SIAr 9%Type
of Identification
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Produced
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produ ed
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(Signature of Notary Public- State of F14, I, e�„ �eN s.. Q�
(Signature of Notary Public- State of Florida
il :" No' 5e o���\��
Commission No. FF 936050 (;''iIC $TA'fE \\\\\
1FF936050 ;'
Com mIS510n N0. FF 936050 '�nQadON. s;'
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
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REVIEW
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DATE
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DATE
COMPLETED
Rev.8/2/17