HomeMy WebLinkAboutBuilding Permit Application i
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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 5/26/2017 Permit Number: ;,/�05 -Qoc��
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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 X
PERMIT APPLICATION FOR: Siding
3,2ED '''.
Address: 7104 PACIFIC AVE
Legal Description: LAKEWOOD PARK-UNIT 11-BLK 146 LOT 6(MAP 13/12N)(OR 3995-1771)
Property Tax ID#: 1301-613-0193-000-8 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Sider
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Stucco Wood House
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itiona wor to e e orme un er t is permit—c ec a appy:
HVAC �Gas Tank ❑Gas Piping _Shutters �Windows/Doors
Electric um ng Sprinklers Generator +_Roof
Total Sq. Ft of Construction: 1760 S . Ft.of First Floor: 1760
Cost of Construction:$ 1930 Utilities:Cn Sewer Septic j,Building Height:
�c r ,�k i� r - - gyros R .ESS � �� .:. .CQ NTACTC � Ez
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Name Arnold Paulo Name: Roderick Waller
Address:6912 Winter Garden PKWY Company: Sunrise City CHDO, Inc.
City: Fort Pierce State:FL Address: 3550 Okeechobee`Rd
Zip Code: 34951 Fax: City: Fort Pierce State:FL
Phone No. Zip Code: 34947 Fax: 772-907-0420
E-Mail: Phone No. 772-20142850
Fill in fee simple Title Holder on next page(if different E-Mail: rodwaller1@gmail.c6m
from the Owner listed above) State or County License: CGC1515114
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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SURPEXMENTAL CO3NSTRUCTv,I0N LI L W NF tM1�TIC�Nk '
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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 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 orr recording our Notice of Commencement.
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_Sign ture of Owner-Lessee/Agent Signa ure of Contrac r cense Holder
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STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF ,,Q� COUNTY OF Iza �Q
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of f%o, 1 20 Fl—by thiorl_�__day of ___,,20 n by
(Na e of person acknowledging) (Name of person acknowledging)
(Si at re of Notary Public-Sta of Florida) ignature 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. (Seal) Commission No. )�
LASHAHNA INGRAM
Notary'Public S
Yr,, LASHAHNA INGRA Na Ply comm. Expires Dec 20
Revised 07/15/2014 a°`A `e`�s Notary Public-State of Florida ,. '�'� �°, com r ss;o 201&,
u u 1 °}FSO 77 FF 177249
° ^?My Comm.Expires Dec 20,210""e G �4"""'" Qa {{
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COUNTER 'RE I€VV REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS