HomeMy WebLinkAboutBuilding Permit Application DATE: �p3 FEES DUE: �� ,d® RECEIPT#: Permit
Planning & Development Services Department
Building&Code Regulation Division
2300 Virginia Avenue
o v Ft Pierce,FL 34982-5652_ RECE1 V.Z JUN 13 20]6
Tel.772462-1553
APPLICATION FOR ROOF PERMIT
SEE REVS` E IDE FOR INSTRUCTIONS
1. Location/Site Address: ��- COrC��« DL1c��P
2. Parcel ID Number: �HI 0 ,HOZ 00L ,00()(�
Office Use Section Township Rance Map Pae Zoniva Land Use Initials
Only
3. Description of Projector Work Activity:
4. Total Roof Area(square feet): SA4 Z 5.Roof Pitch: 1 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 Information 8. Contractor Information
Name: Lo(S -P.112S FL Reg/Cert#: CRC. C�Q S-10 CO
Address: 5 Z8 3 co muuQ 's C'C&—til, County Cert#: LUC 1 f.
City: State: L Business Name: 500sAn LC ISS
Zip: Phone: Cell Phone:.-T1?-.:-- 'MM-
9.
hone: -T1?-.:-- -9. Value of Construction: $ f� ylo
"Note Dry-in and Final Inspection Required. Additional inspection may be required per Product Approval.
CONTRACTOR/OWNER'S AFFIDAVIT: I certify that all of the information contained in this application is correct and that all work will be
l done in compliance with all applicable laws regulating construction and zoning.
s
PRINT QUALIFIERS/OWNERS NAME SIGNATURE OF QUALIFIER/OWNER
STATE OF FLORIDA,COUNTY OF
ACKNOWLEDGED BEFORE ME THIS-2—DAY OF -SURL 20-1�a,BY A DV WHO
--
WHO IS PERSONALLY KNOWN 4�TO ME OR HAS PRODUCED AS IDENTIFICATION
S GNATURE OF NOTARY TYPE OR PP�T NAME OAF N n0-TY a%e,',j
Nptary Public State of Fbrida
Kahfea HamptonCOMMISSION NUMBER 1 [ ) Ii ExpiMy res 0Ul t?J2020ion FF ab7317NOTICE TO OWNER: FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAA IC
FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING,CONSULT YOUR LENDER OR
ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
Revised 426/2010
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