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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 1 c� �
Date: 7/17/2017 Permit Number: r ! `7 " U-3/ 0
RECEIVED
Building Permit Application JUL 1 C01�
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:
PROPOSED`I,M'PROUEMENTXLQCATIO`N; . ;%
Address: 7505 SANTA CLARA BLVD, Fort Pierce FL 34946
Legal Description: LAKEWOOD PARK-UNIT 7-BLK 71 LOT22(MAP 13/02N)(OR 2934-2701;3387-2949)
Property Tax ID#: 1301-607-0050-000-5 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED b' S` RIPTION OFWORK eb "`
Stucco entire house
CONSTRUCTION INFORMATION 9
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Additionalwork to be eF orme � under this permit–check all apply:
❑HVAC Gas Tank Gas Pi Windows
— in _❑ P g Shutters ❑ Doors/
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Electric' 0 Plumbing Sprinklers Generator _J Roof
Total Sq. Ft of Construction: 1248 Sq. Ft. of First Floor: 1248
Cost of Construction:$ 2150.00 Utilities:[]Sewer❑Septic Building Height:
OWNER%LESSEE "CONTRACTOR x
Name 7505 Santa Clara Blvd Land Trust Name: Roderick Waller
Address:7050 W Palmetto Park RD Ste 15-675 Company: Sunrise City CHDO, Inc.
City: Boca Raton State:FL Address: 3550 Okeechobee Rd
Zip Code: 33433 Fax: City: Fort Pierce State.FL
Phone No. Zip Code: 34947 Fax: 772-907-0420
E-Mail: Phone No. 772-201-2850
Fill in fee simple Title Holder on next page(if different E-Mail: rodwallerl @gmail.com
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.
rSU`PP<LEMENTIAL CONSTRUCTIQN LI '4 EA INF®RMATION
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 orrecordingour Notice of Commencement.
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_Signature of Owner Lessee/Agent Signature of Co tractor/License Holder >�--
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instr ent was acknowledged before @ OE
this day of 20/ by . z this�day of 20 �by 2W
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(Name of person acknowledging) ;a�?`' "off (Name of person acknowledging)
(Signature of Ni6yary Public-State of Flori'da V (Signature of Not Public-State of Florida)
Personally Known OR Produced Identification Personally Known C__�OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. (Seal) Commission No. (Seal)
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS