HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ( 0n9_(Y4W
Date: 9/23/16 Permit Number:
i a i AN- -9
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 LOCATION:
Address: 1291 Nettles Blvd Jensen Beach, FL 34957
Legal Description: Nettles Island Inc,A Condo-Section II Parcel 1291 And Pro-Rata Share in Common Elements(OR 3800-196)
Property Tax ID#: 4502-501-1478-000-9 Lot No.
Site Plan Name: Rasmussen Residence Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Remove shingle roof and replace with metal
CONSTRUCTION INFORMATION:
Additional work to be nerforryied under t ispermit—check a appy:
HVAC Gas Tank Gas Piping _Shutters a Windows/Doors
11 Electric ❑ Plumbing Sprinklers I Generator Z Roof
Total Sq. Ft of Construction: 782 S . Ft. of First Floor: 782
Cost of Construction:$ 5500 Utilities: Sewer[]Septic Building Height: 8 Ft.
OWNER/LESSEE: CONTRACTOR:
Name Donald&Jacquelyne Rasmussen Name: Jamie Cisco
Address:1410 N Leavitt Avenue Company: Sunshine Roofing, LLC
City: Orange City State:Fl Address: PO Box 1083
Zip Code: 32763 Fax: City: Palm City State:FI
Phone No.386-717-5007 Zip Code: 34991 Fax:
E-Mail: Phone No. 772-260-8195
Fill in fee simple Title Holder on next page(if different E-Mail: sunshineroofingllc(cD-gmail.com
from the Owner listed above) State or County License: CCC1327796
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 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.
ts-ibnaylre of ner/Age t/Lessee Signature- f Contractor/License Holder
STATE OF FLOR DA STATE OF FLO DA iiA
COUNTY OF_TCUV'A-�(� COUNTY OF '�`k��t"1
The forg Ing instrument was acknowledge before me The forgoing instrument was acknowledged before me
this day of 20by this,;; ' Iayof ,20 ,by
Jamie Cisco
(Name of p rson ackno ledging) (Name of person acknowledging)
Si ature of Nc#ary Public-State of Florida) (S' ature of Notary P,Zc-
n,'ate of Florida)
Personally Known OR Produced Identification Personally Known y Produced Identification
Type of Identification ProducedType of Identification Produced
bodbodbodhodh
Commission No. FF11908 ,a��'!�'p��., (Seal) o mission Nor -/7(j ,C
aLYS$cisco
Noury pub -Swe 01 Flo ids JOANNE I.GRANESE
% �t��•+r My Comm.Expires Jul 18,201e
�mw EXPIRES:November24,2019
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS