HomeMy WebLinkAboutBuilding Permit Application ALL APPLICA LE 1 O MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED `` ^ 1
Date: �� ti� Permit Number:_IL0 i DLA' 0 (P
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: 6903 Santa Clara Blvd, Fort Pierce, FI 34951
Legal Description: LakeWood Park-Unit 9-BLK 102 Lot 15
Property Tax ID#: 1301-611-0045-000-0
Lot No.
Site Plan Name: Block No.
Project Name: Frank Sportell JR
Setbacks Front Back: Right Side: Left Side:
.DETAILED DESCRIPTION OF WORK;
ills,_t .
tSA1101 n1100k -4
3� T��n k I�ecf a 3�
CONSTRUCTION INFORMATION:
Additional work to be performed under tispermit—check all appy:
HVAC Gas Tank Gas Piping _ShuttersWindows/Doors
Electric Plumbing Sprinklers Generator ERoof Roof pitch
i
Total Sq. Ft of Construction:�p b)u S . Ft. of First Floor:
Cost of Construction:$ I1 ® Utilities:�SewerE:l Septic Building Height:
OWNER/LESS.EE: CONTRACTOR:
Name Frank Sportell JR Name: Matt Drozd
Address:6903 Santa Clara Blvd Company: Diversified Roofing Solutions, Inc
City: Fort Pierce State:FL Address: 1195 Old Dixie Hwy Ste 17
Zip Code: 34951 Fax: City: Lake Park ; ' State:FL
Phone No. Zip Code: 33403, Fax:
E-Mail: Phone No. 561-841-5676
Fill in fee simple Title Holder on next page(if different E-Mail: geris@diversifiedroofingfl.com
from the Owner listed above) State or County License: CCC1330205
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 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 recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing, c ns It ith lender or an attorney before
commencin nor recordin our Notice of Commenceme t.
s
Signature of Owne k Le a Co tractor as Agent for Owner Signat r o .0 tractor icense Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF Palm Beach COUNTY OF Palm Beach
The for oing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day ofTl1apea Aeu - 20�by this day of 20 by
(Name of person acknowledging) (Name of person acknowledging)
r _
(Signa re of Notary Public-State of Florida (Signature of Notary Public-State of Florida)
Personally Known (/ UR Produced Identification Personally Known OR Produced Identification
Type of Identificatio Type of Identification Produced
.v�'�� is GERI K SHUBERT
Commission No. *='K&COMMIJSvag0GG006600 Commission No. (Seal)
F EXPIRES October 07,2020
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS