HomeMy WebLinkAboutBuilding Permit Application DATE: EES DUE: RECEIPT#: Permit#:
-- ------- — ---- Planning &Development Services(Department
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= Building&Code Regulation Division
r 2300 Virginia Avenue
Ft Pierce,FL 34982-5652
Te1.772-462-1553
APPLICATION FOR ROOF PERNUT
SEE 3�ERSE SIDE FOR INSTRUCTIONS 1 �4��
1. Location/Site Address: is ��U 1� � S � ,P s�� k,
2. Parcel 11)Number: -7Lk 1000 —�
Office Use Section TownshipRange Ma Pae ZoningLand Use Initials
Only F 71
_ r I
3. Description of Projector`work Activity: 1 O PG(r,,��O in dv\
4. Total hoof Area (square feet): `� 5.Roof Pitch:
6. Type of hoof: [ ]Fiberglass Shingle ( ] Concrete hoof Tile [ ] good Shake/Shingle
[ ] Tar& Gravel [ Modified Bitumen [ ] Other
IV Product Approval required for all types of Roofmg(material(2 Sets)
[ ] All Commercial Roofing requires design by an Engineer or Architect(2 Sets)with Product
Approval attached
`* Roof Mitigation per F.S. 553.844 will be required.
7. Owner Information 8. Contractor Information, //
Name: thea .y� '.1 oafo- 1FL Reg/Cert#: ---Z�OS-7�1 b
Address: ;A-7 (7- kkm e , County Cert#: Z
City: ���5 State: Business Name�(�o ` � QNJ(
Zip•��a �Z Phone: 7 �Z7i�7 Cell Phone: 772Ll 677
9. Value of Construction:
**Note Dry-in and Final Inspection Required. Additional inspection may be required per Product Approval.
CONTRACTOR/OWNER'S AFFIDAVIT: I certify that all ofth information contained in this application is correct and that all work will be
1 rr w ^ done in compliance 'th all applicable laws regulating construction and zoning.
PRINT Q IFIERS/OWNERS NAME SIGNATURE OF QUALIFIER/OWNER
STATE OF FLORIDA,COUNTY OF St
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ACKNOWLEDGED BEFORE ME THIS DAY OF 2D ,BY -Z
S"u
tERSONALE KNOWN TOMEORHASPRODUCE L AS IDENTIFICATIONURE OF NOTAR TYPE OR PRINT N F NOTARY (seal)
COMMISSION NUMBER
NOTICE TO OWNER: FAILURE TO RECORD-A NOTICE OF CO FWVWT& v 1W,-Qx rs TA WUR PAYING TWICE
FOR(IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO TF�P$�NANCH0,%W Iit�r1P YOUR LENDER OR
ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCE ,`�s, Notary Public•c'
' My Comm.ExI:
Revised 4/26/2010 �y 0.. = Comm,
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