HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:�p JC . VJ50�
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
PROPOSED LNPROVEMENT;LOCATIOQN
Address: 7005 SANTA ROSA PARKWAY
Legal Description: LAKEWOOD PARK UNIT 11 BLK 148 LOT 20
Property Tax ID#: 1301-613-0261-000-6 Lot No.
Site Plan Name: Block No.
Project Name:ST. LUCIE HABITAT FOR HUMANITY- REROOF
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION 'QF WORK
TEAR-OFF SHINGLE . RE-NAIL DECK. INSTALL NEW SHINGLE ROOF SYSTEM OVER SELF-ADHERED
UNDERLAYMENT. (28S0./2:12P)
CONSTRUCTION INFORMATION
Additional work toe nertormed under this permit—check all that appy:
HVAC Gas Tank ❑Gas Piping _Shutters []Windows/Doors
11 Electric 0 Plumbing Sprinklers Generator W1 Roof
Total Sq. Ft of Construction: 2800 SFt.of First Floor:
Cost of Construction:$ 8,480.00 Utilities"nSewer Septic Building Height:
OWNER/LESSEE
"t,04T
Name ST. LUCIE HABITAT FOR HUMANITY Name: KYLE WHITE
Address:7005 SANTA ROSA PARKWAY Company: J.A.TAYLOR ROOFING, INC.
City: FORT PIERCE State:FIL Address: 302 MELTON DRIVE
Zip Code: 34951 Fax: City: FORT PIERCE State:FL
Phone No. 772-464-1117 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.
SUPPLEMENTAL CONSTRUCTION LIENNLAVI/ INFC?RMATION
,� .....it ,. �r, °3,M.8i 7` 7 �IeJtd i,n2
DESIGNER/ENGINEER: x Not Applicable MORTGAGE COMPANY: x Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: x Not Applicable BONDING COMPANY: x 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 or an attorney before
commencing rk r recording our Notice of Commencement.
r
s i
Signature of Owne /Agent/Lessee Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF SAINT LUCIE COUNTY OF SAINT LUCIE
The forgoing instrument was acknowled ed before me The forgoing instrument was acknowledged before me
this 24TH dayof APRIL 20V_10 by this 24TH dayof APRIL 20_W by
KYLE WHITE KYLE WHITE
(Name of person acknowl d ' ,g) (Name of person acknowledge )
� I
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida )
Personally Known x OR Produced Identification Personally Known x OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. FF115637 _'�v►��h��,
(s REN S. NIELSE C mISSIOn NO. FF115637 (Seal)
^• �' Commission#FF 1156 7
Y P KAREN S. NIE S
M Commission Expire s . �.
Une ;• °k Commission#FF 11563
s+ •a,,��,tia��orMy Commission Expires
Revised 07/15/2014
June,12, 2018
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED