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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED S. - J 7
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Date: azo Permit Number: 6 V
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F L ?D..._R IDA Permitting
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Bui ftr�g�E hit Application ,A.2191g
Planning and Development Services t1n9D®po
Building and Code Regulation Division l elQ eoun" . ent
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:wF
Address: 2897 HARSON WAY, Fort Pierce FL
Legal Description: SAN LUCIE PLAZA S/D-UNIT ONE-BLK 60 N 20 FT LOT 12
Property Tax ID#: 1428-702-1361-000-7 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK*
Re-Roof Tear off old shingle and install new shingles.
CONSTRUCTION INFORMATION .-
Additional work to be ertormed under this permit-check all JiI apply:
HVAC II Gas Tank nGas Piping _Shutters n Windows/Doors
11 l�
Electric 0 Plumbing Sprinklers El Generator Roof 4/12 Roof pitch
Total Sq. Ft of Construction: 2450 -. S . Ft. of First Floor: 2450
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Cost of Construction:$ 5500.00 Utilities: Sewer I (Septic Building Height:
O1 NER/LESSEE. ,- 'CONTRACTOR: R , ,
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Name Angel L Morris Name: Roderick Waller
Address:2897 HARSON WAY Company: Sunrise City CHDO Inc.
City: Fort Pierce State:F_ Address: 3550 Okeechobee Rd
Zip Code: 34950 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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: h �� �
DESIGNER/ENGINEER: E-Not Applicable MORTGAGE COMPANY: EL Not Applicable
Name:Angel L Morris Name:
Address:2897 HARSON WAY,Fort Pierce FL Address: 2897 HARSON WAY
City: Fort Pierce State: City: State:
Zip: Phone Zip: Phone: ___
FEE SIMPLE TITLE HOLDER: 11 Not Applicable BONDING COMPANY: ELNot 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(4or recording your Notice of Commencement.
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Signature of Owner/Lessee/Contractor as Agent for Owner Signa ure of Contract.r/License 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 24th day of May ,2018 by this 24th day of May ,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 L D 1— Produced
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(signature of Notary Pu lic Stat oFlnricla M - = (Signature of Nota blic�State ofiloetda=:�, f��,�� � 4
DEANN>+t�i11RIL GIVENS I,I o F r o! DEANNA MARIE GIVEN�ti
Commission No. IL",'fw.+ eal ION#GGO?2o' + iAYt'OMP�,`
Commission No. _ nt �e8lf #GGOl?o2� '
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e. QY IRES U'ece er 16
Fata Wutslic Undenm+o
Fo;;°' Bonded 1'hni Notary Puhlic Unuenrrii� ; l
't'oce o;;: Bandcd7hru N
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17 1