HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED pp Q(y
Date: Permit Number: II O�Al1
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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: Roof,
I?RC3POSQ IMPROUEMNT LOCATIt7N ry ,..
Address: 6804 Santa Clara BLVD Fort Pierce, FL 34951
Legal Description: LAKEWOOD PARK-UNIT 9-BLK 116 LOTS 1 AND 2(MAP 13/01N)(OR 3041-362)
Property Tax ID#: 1301-611-0328-000-8 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
ONW , "
Re-Roof Tear of old roof install new roof shingles
CtNSTRUCTIQN IN`FORNIATION
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Additionalworkto a er c under t ispermit—check all appy:
HVAC Gas Tank E]Gas Piping _Shutters Q Windows/Doors
Electric ❑ Plumbing Sprinklers Generator Roof 5/12 Roof pitch
Total Sq. Ft of Construction: 3816 S . Ft.of First Floor: 3816
Cost of Construction:$ 6,925 ' Utilities:CnSewer ESeptic Building Height:
P1t�t6WRRjlSS`EE L -''4 .., CbIVTRACTOR
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Name Lucresha A Robinson-Reeves Name: Roderick Waller
Address:6804 Santa Clara BLVD Company: Sunrise City CHDO Inc.
City: Fort Pierce State:FL Address: 1209 S Indian River Dr
Zip Code: 34951 Fax: City: Fort Pierce State:FL
Phone No. Zip Code: 34950 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@gmaii.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.
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SUPPLEMENTAL Ct7N5TRUCTIQN LAN LAW INFORMATIC71 "'
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DESIGNER/ENGINEER: Q Not Applicable MORTGAGE COMPANY: Q Not Applicable
N am e:Lucresha A Robinson-Reeves Name:
Add reSS:6804 Santa Clara BLVD Fort Pierce,FL 34951 Address: 6804 Santa Clara BLVD
City: Fort Pierce State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: El Not Applicable BONDING COMPANY: allot 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
comrp,eingwork or recording ur Notice of Commencement.
1
( A )A, 1A h o L
Sign t of 0 nes essee/Contractor asgent for Owner Signa r ConR cto ce Holder
STATE OF FL IDA 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 4th day of June 2018 by this 4th day of June 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 i Type of Identification
P duced Produced
Sig ture of Notary Public- ate of Florida) (Signature of Notary Public-Sta of Florida)
Seal°
Commission No. ,,��..,,,` ( ) mission No. (Seal)
:21k,K1 P'/ ,� LAbliAHNA INGRAM
` Notary Public-State of FIc rida
a »•=My Comm.Exnir.c nom o
OF F4O� Co mission#FF 177 qg ` .���Yr��a, LA`HAHNA INGRAM `
REVIEWS' FRONT O'N�IN(�onded hfDt�FJ�Ryr# (d , r Ass L NS VEGETATIO ,,i ° ,`#1RffidlEry PAMANGRM9rid
COUNTER - RE� MEW REVIEW dEWj Com .ExREVIEMPO,20"8
DATEa- omm ssian if rr I I I4,J
RECEIVED FOFF�o4`'�
inn u� Bonded thr)ugh National Notary As:n.'
DATE W -
COMPLETED
Rev.8/2/17