HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: December 16,2016 Permit Number: fir"
"„ 'µ, •w.. RECEP.—D DEC 16 2016
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: 2310 Jo Haywood Drive
Legal Description: Citrus Heights S/D Lot 11 (or 1134-1643)
Property Tax ID#: 1432-700-0014-000-0 Lot No.11
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION'OF WORK.`;'"
Tear off, dry in and re-shingle roof
CONSTRUCTION INFORMATION.
Additional work toe e Orme under this permit—check a appy:
❑HVAC Ei Gas Tank ❑Gas Piping _Shutters ❑Windows/Doors
❑Electric ❑ Plumbing []Sprinklers ❑Generator W1 Roof 512 Roof pitch
Total Sq. Ft of Construction: 2034 SFt.of First Floor:
Cost of Construction:$ 6,500.00 Utilities:n Sewer❑Septic Building Height:
OWNER/LESSEE CONTRACTOR:`
Name Dorina L.Jenkins Name:
Address:2310 Jo Haywood Dr. Company:
City: Fort Pierce State:FL Address:
Zip Code: 34946 Fax:772-465-4716 City: State:
Phone No.772-464-3691 Zip Code: Fax:
E-Mail:djenki3@aol.com Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN.LAW INFORMATION-
DESIGNER/ENGINEER: x_Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name: select Portfolio Sewicing,Inc.
Address: Address: P.O.Box 6501
City: State: City: Springfield State: Ohio
Zip: Phone: Zip: 45501-7277 Phone: e00-641-2754
FEE SIMPLE TITLE HOLDER: x Not Applicable BONDING COMPANY: x 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,1 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
commencin or recording our Notice of Commencement.
/ 14—
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Signa re of Owner/Lessee/Con actor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF Pa1mBeachCounty COUNTY OF
The fgrgRing instr ent was acknowledged before me The forgoing instrument was acknowledged before me
this ay of ,� (Xkb 20 lU by this day of 20 by
Sharon C.Meeksl
me of erso ackno led %4o%, (Na a of person acknowledging)
( p �e�y,, SHARON C.MEEKS
Notary Public-State of Florida
ro; My Comm.Expires Aug 19,2018
'•die o?.` Commission#FF 1472
( i nature of Nota ublic- ' ature of Notary Public-State of Florida)
ersonally Known x OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. (Seal) Commission No. (Seal)
Revised 07/15/2014
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