HomeMy WebLinkAboutBuilding Permit Application ALL APPLICA``BB�L INFO M T BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: QCT Permit Number:
Quays
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 INPROVEMENTLOCATION
Address: 10725 S. OCEAN DR., LOT 62,JENSEN BEACH
Legal Description: HOLIDAY OUT AT ST LUCIE BLK G LOT 23& EQUAL PRO-BOAT INTEREST IN COMMON ELEMENTS
Property Tax ID#: 4511-501-0233-000-1 Lot No.
Site Plan Name: Block No.
Pros tce Name:.-'SAMOLUKRESIDENC (Manufactured-Home)=—�-°�
Setbacks Front Back: Right Side: Left Side:
DETAILED DES'CRIPTION OF WORK:
TEAR-OFF MEMBRANE ROOFING. RE-NAIL DECK. INSTALL 5V CRIMP METAL PANEL ROOF SYSTEM
OVER 2-PLY#30 FELT. (9 SQ. / 3:12 P)
'CO_ NSTRUCTION INFORMATION:
, .
Additional
rtormed
❑HVAC or to e Gas Tank under this permit—Gas check appy:
Piping _Shutters ❑Windows/Doors
11 Electric ❑ Plumbing Sprinklers Generator W1 Roof
Total Sq. Ft of Construction: 900 SFt.of First Floor:
Cost of Construction:$ 5,610.00 Utilities:n Sewer ElSeptic Building Height:
OWNER/LESSEE: "" CONTRACTOR:
Name WILLIAM&SHELLY SAMOLUK Name: KYLE WHITE
Address:10725 S.OCEAN DR., LOT 62 Company: J. A.TAYLOR ROOFING, INC.
City: JENSEN BEACH State:FIL Address: 302 MELTON DRIVE
Zip Code: 34957 Fax: City: FORT PIERCE State:FL
Phone No.772-334-4334 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.
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SUPPLEMENTAL CONSTRUCTION LIEN LAW INFQRMATION;:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: x Not Applicable
Name: T.C.B.E,INC. / HARVEY KOEHNEN Name:
Address:7205 ELYSE CIRCLE Address:
City: PORT ST.LUCIE State: FL City: State:
Zip: 34952 Phone: 772-466-5509 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 or an attorney before
commencing wor or rbcording your Notice of Commencement.
Signature of Owner/A�ent/Lessee Signature of Contractor/L cense Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF SAINTLUCIE COUNTY OF SAINT
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 79 day of JUNE 201LTj by this 19TH day of JUNE 20[by
KYLE WHITE KYLE WHITE
(Name of per�Gq ackno I led ' g) (Name of per n acknow edgiA411 )
— Y,(
(Signature df otary 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 �.a•'piru�G� I €N S. NIELSEN FF115637
� mmission No. •'�
Commission# FF 115637 KAREN S. NIELSEN
My Commission Expires • °= 17 Commission
` une ;,+ ,� My commission Expires
Revised 07/15/2014 °����•d� June 12, 2018
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED