HomeMy WebLinkAboutBuilding Permit Application DATE: FEES DUE: RECEIPT#: Permit#:
- Planning & Development Services Department
`a Building&Code Regulation Division
0 2300 Virginia Avenue
Ft.Pierce,FL 34982-5652
Tel.772-462-1553
APPLICATION FOR ROOF PERMIT
SEE REVERSE SIDE .......
1. Location/Site Address: 2 i U S Ca Wl p r o
2. Parcel ID Number:
Office Use Section Township Range Map Pae Zoning Land Use Initials
Only 11
3. Description of Projector Work Activity: e 1rn Ov e e�d Q c,e xi X14;�n��h�� e r 6i
4. Total Roof Area (square feet): 5.Roof Pitch: '� Z
6. Type of Roof: Fiberglass Shingle [ ] Concrete Roof Tile [ ] Wood Shake/Shingle
[ ] Tar& Gravel [ ] Modified Bitumen [ ] Other
],Product Approval required for all types of Roofing Material(2 Sets)
[ ] All Commercial Roofing requires design by an Engineer or Architect(2 Sets)with Product
Approval attached
** Roof Mitigation per F.S. 553.844 will be required.
7. Owner Information11 11 8. Contractor Information
Name: t G�A 41 �11 t 4 FL Reg/Cert#: C C-C o V 6 7S'
Address: Z [ Q SF- Cgs jh n S T County Cert#:
City: PSL State: -'C- Business Name: 14 y-Q in I A sr�T n c.
Zip: 314 q 5-Z Phone: Cell Phone: 7Z?2- Z 6 3 o ku
9. Value of Construction: $ q
M6
"Note Dry-in and Final Inspection Required. Additional inspection may be required per Product Approval.
CONTRACTOR/OWNER'S AFFIDAVIT: I certify tha all the' ormation contained in this application is correct and that all work will be
_ 11 done in w �p' with al cable laws regulating construction and zoning.
o r U orf Y1 * "'
PRINT QUALIFIERS/OWNERS NAME TURE OF QUALIFIER/OWNER
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STATE OF FLORIDA,COUNTY OF I I'�p 14 Y''t,
.1
ACKNOWLEDGED BEFORE ME THIS DAY OF SCIQt 20BYM:�h btArCll
S PERSONALLYKN WN TO OR HAS PRODUCED AS IDENTIFICATION 2 m
Con N
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SIGNATURE OIFNOTIlit
AIM TYPE OR PRINT NAME OF NOTARY (seal) s
COMMISSION NUMBER
NOTICE TO OWNER: FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE
FOR 1WROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING,CONSULT YOUR LENDER OR
ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
Revised 4/26/2010