HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE
INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED _
Date: (' 1�l Permit Number: �J 11 033
RECEIVE®
Building Permit Application JUL 2 3 2015
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 X
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: Roof
Address: 2207 JO HAYWOOD DRIVE, FORT PIERCE
Legal Description: CITRUS HEIGHTS S/D LOT 22
Property Tax ID#: 1432-700-0025-000-0 Lot No.
Site Plan Name: Block No.
Project Name: ROCHESTER REROOF
Setbacks Front Back: Right Side: Left Side:
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TEAR-OFF SHINGLE. RE-NAIL DECK. INSTALL NEW SHINGLE ROOF OVER#30 FELT UNDERLAYEMENT.
(33 SQ. ! 5:12 P)
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Additional worK toe nertorrne under tis permit—cneCK all appy:
HVAC 0 Gas Tank ❑Gas Piping _Shutters a Windows/Doors
11 Electric 0 Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: 3300 SFt.of First Floor:
Cost of Construction: $ 7,360.00 Utilities: Sewer Septic Building Height:
Name BARBARA ROCHESTER&BRYANT WILBURN Name: KYLE WHITE
Address:2207 JO HAYWOOD 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.772-475-8999 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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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 inspe tion. If you intend to obtain financing, consult with lend r or an attorney before
commencing wo or ecording your Notice of Commencement. 11
Signature of Owner—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 acknowledged before me The forgoing instrument was acknowledged be-fore me
this 22ND day of JULY 20Mby this 22ND day of JULY 20=by
KYLE WHITE KYLE WHITE
(Name of person acknowlefgin�) (Name of perso cknowl dgi g)
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(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 Tyn of Identification Produced
, REN S. NIELSE
Commission NO. FF115637 +�"T'"dny FF115637
(5@ mission# FF 115 3Qo fission No.
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mission Expires AMIS. NlELSEN
Commission#FF 11563
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Revised 07/15/2014 ",;;;°'� June 12, tot s
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