HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
w.
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential X
PERMIT APPLICATION FOR: Roof
PF OPOSEDIN_'IkOVEMENT_LOCATIa'N`
Address: 5007 STAR AVE., FORT PIERCE
Legal Description: CENTRAL WHITE CITY S/D BLK 2 LOTS 16, 18&20
Property Tax ID#: 3403-804-0023-000-1 Lot No.
Site Plan Name: Block No.
Pro'ect Name: JAXON LLC(Tim Grimes]/RER90F--�
Setbacks Front Back: Right Side: Left Side:
pad-, � n . M,�.>. ^ " s �ko i;u. � ''' ._s�aaswh. �"a ,n�u 1�+,1.�"�``"� a,m�'✓�s�"�'� z„a u..G�"�,"�'G'�"'i �: flu�",,
TEAR-OFF SHINGLE. RE-NAIL DECK. INSTALL NEW 5V CRIMP METAL PANELS OVER#30 FELT UNDERLAYMENT.
(4:12P / 40SQ.)
F d Pa. �
xi, h.ar ,.., �i"-1. �v d. * d 2!H'4E wali-'� `a
MOON
Additional
� � a � ��
itionalwor to be nertormpd under tis permit—check all appy:
HVAC Gas Tank Gas Piping _Shutters n Windows/Doors
U
Electric 0 Plumbing Sprinklers Generator W1 Roof
Total Sq. Ft of Construction: 4000 S . Ft.of First Floor:
Cost of Construction:$ 10,000.00 Utilities:Sewer Septic Building Height:
eAs+ae rz�%
ar"`
>.. e �,. CO,NTRAC 'OR
OU4tNER/LESS E
Name JAXON LLC Name: KYLE WHITE
Address:2529 N. INDIAN RIVER DRIVE Company: J.A.TAYLOR ROOFING, INC.
City: FORT PIERCE State:FL Address: 302 MELTON DRIVE
Zip Code: 34946 Fax: City: FORT PIERCE State:FL
Phone No. 772-216-3001 Zip Code: 34982 Fax: 772-468-8397
E-Mail: Phone No. 772-466-4040
Fill in fee simple Title Holder on next page(if different E-Mail: karenfortaylor@aol.com
from the Owner listed above) State or County License: CCC1325895
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPLEMENTALCONSTRUCTION lIE`� LAW INFCRIUTATION s �, {
a .. ". w .� p
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: x—Not Applicable
Name: T.C.B.E.,INC. / HARVEY KOEHNEN Name:
Address:7205 ELYSE CIRCLE Address:
City: PORTST.LUCIE State: FL City: State:
Zip: 34952 Phone: 7729-466-5509 Zip: Phone:
FEE SIMPLE TITLE HOLDER: x Not Applicable BONDING COMPANY: Not Applicable
Name: 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 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 r an attorney before
commencing Work fpr recording our Notice of Commencement.
e
Signature of Ow /Agent/Lessee Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF SAINTLUCIE COUNTY OF SAINTLUCIE
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 17TH day of APRIL 20M by this 17TH day of APRIL 201 L-211by
KYLE WHITE KYLE WHITE
(Name of perso cknowl dg' g) (Name of person acknowle inml
5--��
(Signature of Notary Public-State of Florida) (Signature of Notary Public-giafe of Florida)
Personally Known x OR Produced Identification Personally Known x OR Produced Identification
Type of Identification Produced Type of Identification Produced
)KI REN S. NIEL E
Commission No. FF115637 Al° �e,�eaC dim ssion No. FF115637
:*®*, ommission# FF 11 637 KAREN S. NIELS
+,y My Commission Ex ires =11 1 * *? CommissionIF FF 11 37
�..
an,,,,,a•• Julle 1 4.2 e y ommiss�on Expi s
Revised 07/15/2014
?,w,',;.•` June 12, 2018
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED