HomeMy WebLinkAboutBuilding Permit Application r Imo' I i
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED f
Date: Permit Number: 1 >
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 IMPROVEMEN= LOCATION
Address: 7203 DONLON RD, Fort Pierce FL
Legal Description: LAKEWOOD PARK-UNIT 11-BLK 143 LOT 30(MAP 13/12N)(OR 836-1197)
Property Tax ID#: 1301-613-0145-000-7 Lot No.
Site Plan Name: ! Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:,
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DEl'AILED DESCRIPTIONQFI�WO�RK
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Remove and Replace 22 sq Shingles
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CONSTRUCTIQN INFORMATION
Adclitional worK toe e orme under this permit—c ec a appy: _ k
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HVAC Ei Gas Tank ❑Gas Piping _Shutters ❑Windows/Doors
❑Electric F-1PlumbingSprinklers ❑Generator YJ Roof 412 Roof pitch
Total Sq. Ft of Construction: 1440 Sq. Ft.of First Floor: 1256 i
Cost of Construction:$ 8500.00 Utilities: Sewer LJSeptic Building Height:
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OWNER%LESSEE 7Y , ,, CONTR'AdT®R ¢qy@
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Name Cynthia L Shinn Name: Roderick Waller
Address:7203 Donlon RdCompany: 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. 772-201'-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 Licenser 6CC1327208
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required. j
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SIJPP'LEMENTA$L CONSTR`UCTI:ON L61EN�ILA
IN I'NF$ORMATI®N r fy d
!DESIGNER/ENGINEER: ✓Q Not Applicable MORTGAGE COMPANY: j ✓ L Not Applicable
N a m e:Cynthia L Shinn Name: I
Add ress:7203 DONLON RD,Fort Pierce FL Address: 7203 Donion Rd !
City: Fort Pierce State: City: I State:
Zip: Phone Zip: Phone:
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FEE SIMPLE TITLE HOLDER: 0 Not Applicable BONDING COMPANY: ` allot Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
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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 mayirestrict 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 followin buildin I
g g 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 olr an attorney before
commencing work or recording our Notice of Commencement.
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Signature of Owner/Lesse / on ra or as Agent for Owner Signature of Contractor/Licen'e Holder
STATE OF FLORIDA STATE OF FLORIDA
i COUNTY OF St Lucie County COUNTY OF St Lucie County I
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 13th day of March 20 18 by this 13th day of March ;20 18 by
I Roderick Waller Roderick Waller
I 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
Produ Produced I
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(S1gnat i rg,"' ary PSWHiAeld Afi (Signature of Ndtary(Public-State of Florida)
MY COMMISSION#FF997093
Comm! ` CYDIDCc f,A�y 30 2d a0 Commis olR`• Y`°8:: 30PNIA HARRI&eal)i
MY COMMISSION#>FF997093 i
(401)3980153 FlorideNotaryServlce.00rn
j .7? ftp EXPIRES May 30,2020
NGrary$BrvICA.pprn
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED i
DATE
COMPLETED
Rev.8/2/17
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