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OMPLETED FOR APPLICATION TO BE ACCEPTED / �-L,.J�
Date: F �v Permit Number: ( 10— cc
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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 XXXXX XX
PERMIT APPLICATION FOR: Roof
PROPOSED IM:PROVEMENT,LOCATIO.N
Address: 591 BARB ANN LANE PORT ST. LUCIE, FL 34952
Legal Description: LA BUONA VITA COOPERATIVE UNIT/LOT 61 (OR 1432-735)
Property Tax ID#: 3426-664-0061-000-2 Lot No.61
Site Plan Name: Block No.
Projgrt Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK
REMOVE EXISTING ROOF
REPLACE ANY ROT
INSTALL ASTM-226 30# UNDERLAYMENT
INSTALL 26 GA METAL ROOF SYSTEM 1
CONSTRUCTION INFORMATION
Additional work to be nertormed under this permit–check all appy:
HVAC Gas Tank []Gas Pip ing _Shutters Q Windows/Doors
Electric 0 Plumbing Sprinklers F Generator W] Roof
Total Sq. Ft of Construction: 1,150 SFt.of First Floor:
Cost of Construction:$ 5,475 UtilitieslnSewer Septic Building Height:
,OWNER/LESSEE:.,. CONTRACTOR:
Name ELMER&EVA JOYCE PRUSS Name: JOE BAKER
Address:591 BARB ANN LANE Company: BIG LAKE ROOFING&REPAIRS
City: PORT ST. LUCIE State:FL Address: 2699 NW 16TH BLVD.
Zip Code: 34952 Fax: City: OKEECHOBEE State:FL
Phone No.772-878-8550 Zip Code: 34972 Fax: 863-763-7662
E-Mail: Phone No. 863-763-7663
Fill in fee simple Title Holder on next page(if different E-Mail: BIGLAKEROOFING@YAHOO.COM
from the Owner listed above) State or County License: CCC046939
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL
\
PPLEMENTAL CONSTRUCTION't-IEN LAW INFORMATION:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: of Applicable
Name: ASMUSSENENGINEERING LLC. Name:
Address:P.O.Box 1998 Address:
City: OKEECHOBEE State: FL City: State:
Zip: 34973-1998 Phone: 863-763-8546 Zip: Phone:
FEE SIMPLE TITLE HOLDER: of Applicable BONDING COMPANY: ViNlot 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 thepermit 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.
Signature of Owner/Agent/Lessee Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF �k--P e � COUNTY OF � � ,-LlIo'ne-
The f rgc�Ing instru ent w acknowledged before me The forgong instrume�acknowledge .before me
thi 15 ay of 20 -by this ay of r 20_[�by
(Name of person acknowledging) (Name of person acknowledging)
(Signature ofa Public-State Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. ,,�,,, (Se@L) Commission No. � �er Edw
$tiP gather Edwardscin Ply arason
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Revised 07/15/2014 SM
EXPIRES: May 21, 2018 %, gid;; EXPIRES: May 21, 2018
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