HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED I
Date: 2, 1 _ Permit Number: 6 2 C),
FF
IVED
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Building Permit Applicatio8 2018
Planning and Development Services . eCounty, Parrnittin
Building and Code Regulation Division 9
1300 Virginia Avenue, Fort Pierce FL 34981
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential X
PERMIT APPLICATION FOR: Roof
PROPOSED IMPROVEMENT LOCATION:
Address: 7902 KENWOOD RD, Fort Pierce FL
Legal Description: LAKEWOOD PARK-UNIT 5- BLK 49 LOT8 (MAP 13/02S) (OR 4097-1800)
Property Tax ID#: 1301-605-0240-000-8 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK: -
Remove and Replace 26 sq Shingles
CONSTRUCTION INFORMATION:
Additional work to ff
rorme un er t is permit—c ec a appy:
HVAC Gas Tank []Gas Piping Shutters ❑Windows/Doors
Electric ❑ Plumbing Sprinklers Generator Roof 412 Roof pitch
Total Sq. Ft of Construction: 1243 SFt. of First Floor: 1243
Cost of Construction: $ 4,500 Utilities:n Sewer 11 Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Hildegard Chueprasert Name: Roderick Waller
Address:5250 SW 25th Street Company: Sunrise City CHDO Inc.
City: Vero Beach State:FL Address: 3550 Okeechobee Rd
Zip Code: 32968 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: CCC1327208
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
,s
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Q Not Applicable MORTGAGE COMPANY: Q Not Applicable
N am e:Hildegard Ohueprasert Name:
Address: 7902 KENWOOD RD,Fort Pierce FL Address: 5250 SW 25th Street
City: Vero Beach State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: 0 Not Applicable BONDING COMPANY: QNot Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
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 or recording our Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/tJcense Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF St Lucie County COUNTY OF St Lucie County
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 28th day of February 20 18 by this 28th day of February 20 18 by
Roderick Waller Roderick Waller
Name of person making statement Name of person making statement
Personally Known X OR Produced Identification Personally Known X OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Signature of Notary Public-State of P orida) (Signature of Not ry Public-State of Florida)
Commissior Nn CommissionSOPHIA jalHAR
a
SOPHIA HARRIS
`!= MY COMMISSION#FF997093
'c MY COMMISSION#FF997093 ,
R020-
EXPII IIES May 30,2
REVIEWS t40 ►aae FERVISOR PLANS tWaYe•o,s3 Ft.idsNcteryrFrR ANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17