HomeMy WebLinkAboutBuilding Permit Application ` 8230861
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:C`� `�o�
l Permit Number: IS05 ��
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 IMPROVEMENT LOCATION21
Address: 366 Johnston St. Fort Pierce, FL 34982
Legal Description: REPLAT OF PALM GARDENS BLK 4 LOT11 (0.17 AC)(OR 240-776 : 1312-2127),
Property Tax ID#: 3403-802-0049-000-3 Lot No.11
Site Plan Name: Block No. 4
Project Name: Phillips,#8230861
Setbacks Front Back: Right Side: Left Side:
DETAILEDbESCR'IPTI0N'4 WORK:
re-roof 13 squares of low slope
CQNSI RUCTION INFORMATION
Additional work toa .r orme under this permit—check a that appy:
E1HVAC -Gas Tank Gas Piping Shutters Windows/Doors
Electric ❑ Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: �� Sq. Ft. of First Floor:
Cost of Construction: $ 7,295.00 Utilities:[]Sewer Septic Building Height:
OWNER/LESSEE "" "'CONTRACT
OR' '
Name Patricia Williams Name: Quinn Roberts
Address:366 Johnston St. Company: The Home Depot At Home Services
City: Fort Pierce State:FL Address: 674 S Military Trail
Zip Code: 34982 Fax: City: Deerfield Beach State:FL
Phone No.(502)363-4588 Zip Code: 33442 Fax:
E-Mail: Phone No. (954)379- 1500
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License: CCC058327
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
fis
/�.J l
SUPPLEMENTAL CONSTRUCTION LIEN LAW 1NF=ORNIA 10
_
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:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
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
com ncln work'or recordin our otice of Commence en .
Signature of wner/Agent/Lessee Signature of ontractor/License Hol er
Y,STATE OF FLORIDA STATE F FLORIDA
COUNTY OF COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of Ajn!t'y 20 15 by this 1Y day of _,20 15 by
Quinn Roberts 1 Quinn Roberts
(Name of persoging) (Name o ac no e g,
r
na ure of Notary Public-State of Florida) (Si otary 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. 4WWHONALLEN THO mmission No. JOW*HONALLEN T'HO
NOTARY PUBLIC NOTARY PUBLIC
OF RIDA
OF FLORIDA
Revised 07/15/2014 Comm#FF055234 Comm#FF056234
e Expires 9/18/2017 a Expires 9/18/2017
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS