HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ls Permit Number: y "1 r / 4-5
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 LOCATIO,N�:
Address: 2994 Conifer Drive, .Fort Pierce, FL 34951
Legal Description: Hole in One Circle Lot 4 (0.56 AC)(OR 3702-2211)
Property Tax ID#: 1327-803-0004-000-0 Lot No. 4
Site Plan Name: Block No.
Project Name: Charles Rarick Reroof/ZelahzA
Setbacks Front Back: Right Side: Left Side:
DETAILED;DESCRIPTION Of WORK':
71!�1_44Z_WFf?c0=1bf Low Slope Roof. &q 5T
e +Woof's a built u Modified (Like for like replacement)
OAILY / 5` 041 s'�ZT"oil OFo/'7E
CONSTRUCTION'IN FORMATION:
Additional work toe nertormed under this permit—check all appy:
HVAC 0 Gas Tank ❑Gas Piping _Shutters Q Windows/Doors
Electric 0 Plumbing Sprinklers E Generator 11 Roof
Total Sq. Ft of Construction: A6 sf S . Ft.of First Floor:
Cost of Construction:$ 4,990 Utilities. Septic Building Height:
OWNER/LESSEE CONTRACTOR:
Name Charles Rarick Name: Larry Neese
Address: 2994 Conifer Drive Company: Larry Neese, Ur-
City: Fort Pierce State: FL Address: 2801 Sunrise Blvd
Zip Code: 34951 Fax: city: Fort Pierce State: FL
Phone No. 561-414-7329 Zip Code: 34982 Fax: 772-361-6581
E-Mail: charlesrarick@comcast.net Phone No. 772-361-6580
Fill in fee simple Title Holder on next page(if different E-Mail: larry@LNroof.com
from the Owner listed above) State or County License: FL CCC1330608
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: _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 froMUndergoing a full concurrency review:room ad ' ions,
accessory structures,swimming pools,fences,walls s,screen rooms and accessory uses to another n-residential use
WARNING TO OWNER:Your failure ecord a Notice of Commencement result' your paying twice for
improvements to your propert Notice of Commencement m e reco ed nd posted on the jobsite
before the ection. ou intend to obtain financing, nsult wit nd or an attorney before
comme cin wo or re rdin our Notice of Commence ent.
s
Si ature of 0 r/Lessee/Agent ;A�T
re of Contracto icense Holder
STATE OF FLORIDA - LORID
COUNTY OF i ,QA ac,��Q , COUNTY OF=
The forgoing inst en was acknowledged before me The forgoing ins me was acknowledged before me
this"� I day of 20 l�by this day of 20(1 by
(Name of pers n cknow edging) (Name of person c nowledgi g)
(Signature of Notary Public-State bf Florida) (Signature of Notary Public-State of Florida)
Personally Known OR ProducecL ProduceIdentification Personally Kno n OR Pro uc Identification
Type of Identification Pro 'Q'c8`''
�zA. Type of Identifi a ioq;rq? SRI
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s �•� Notary Public pt F;crid2 ,
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Commission No. _ 1. ��ea
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Revised 07/15/2014 "
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