HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE NFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED / �)
Date: /��J Permit Number:
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 INP,ROVEMENT WtATIO'N:
Address: 377 BAYSINGER AVE, FORT PIERCE
Legal Description: REGINA PALMS S/D BLK 10 W 10.8'OF LOT 22,ALL LOT 23& E 12.4'OF LOT 24
Property Tax ID#: 3403-501-0255-000-6 Lot No.
Site Plan Name: Block No.
Project Name: TKG12 LLC REROOF` --�
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION;OF WORK. =-
TEAR-OFF SHINGLE . RENAIL DECK. INSTALL NEW SHINGLE ROOF OVER#30 FELT
(12 SQ. / 6:12&3:12 P)
CONSTRUCTION INFORMATION A puss '
v
w
Additional work toe performed
_ under this permit—check all appy:
HVAC Gas Tank ❑Gas Piping _Shutters Q Windows/Doors
Electric 0 Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: 1200 S Ft.of First Floor:
Cost of Construction:$ 2450.00 Utilities:Sewer Septic Building Height:
01NN ER/LESSEE rv= CONTRACTOR
uv�: �._
Name TKG12 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: 72-468-8397
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 LIEN"LAW INFORMATION:` ,
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: 772-466-55o9 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 work or recording our Notice of Commencement.
8
Signature of Owner/Age
.!mt7Msee Signature of Contrac d1-/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 9TH day of JULY 20M by this 9TH day of JULY 20Mby
KYLE WHITE KYLE WHITE
(Name of person acknowled ing) (Name of per acknowledgi )
l
(Signature o 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 op;""
' i: K EN S. NIELSEN mmission No. FF115637 (Seal)
,b
Commission# FF 115637 KAREN S. NIELSEN
-P rxpil 11oa Y :rte �= ommisslon
Revised 07/15/2014 % °"` June 12, 201 8 Y
��� ''t P��� M Commission Expires
'OF June June 12, 2018
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED