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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED faL0 . 051c1
Date: Permit Number:
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Building Permit Application 474%, ''?g8
Planning and Development Services �' n,b,
Building and Code Regulation Division QG7q,,_
2300 Virginia Avenue,Fort Pierce FL 34982 �� ����``
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential X
PERMIT APPLICATION FOR: Roof
PROPOSED'IMPROVEMENTHLOCATION: `'
Address: 6290 N US HIGHWAY 1, Fort Pierce FL
Legal Description: 5/6 34 40 FROM NW COR OF NE 1/4 OF SE 1/4 OF SEC 6,TH E ALG 1/4 SEC LI 239.65
Property Tax ID if: 1405-320-0003-000-0 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 Shingles Roof and install new. FL10124-R20 Shingles. FL16048-R6
CONSTRUCTION INFORMATION
Additional work to be performed under this permit—check all apply:
HVAC _Gas Tank nGas Piping _Shutters ❑Windows/Doors
ElElectric El [Plumbing Sprinklers El Generator I Roof 4/12 Roof pitch
Total Sq. Ft of Construction: 3650 sot Ft.of First Floor: 3650
Cost of Construction:$ 8800.00 Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE = CONTRACTOR.; °
Name Michael D Chaussee Name: Roderick Waller
Address:1607 Ridgeway Ave Company: Sunrise City CHDO Inc.
City: Colorado Springs State:CO Address: 3550 Okeechobee Rd
Zip Code: 80906 l Fax: City: Fort Pierce State:FL
Phone No. I 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.
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SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION .
DESIGNER/ENGINEER: ✓Q Not Applicable MORTGAGE COMPANY: Q Not Applicable
Name:Michael D Chaussee Name:
Address:6290 N US HIGHWAY 1,Fort Pierce FL Address: 1607 Ridgeway Ave
City: Colorado Springs State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: 0 Not Applicable BONDING COMPANY: Not 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')wok or recording your Notice of Commencement.
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Signature oil Owner Lessen Contractor as Agent for Owner Si natur�of Contractor License Holder
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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 21th day of June ,20 18 by this 21th day of June ,20 18 by
Roderick Waller Roderick Waller
Na a of percnn making ctatament Name of person making statement
Personally •ng:":it GOMAlcvardialification Personally Known X OR Produced Identification
Type of Ide ti ic)'oa: MY COMMISSION#FF997093 Type of Identificat�o•lr,;� SOPHIA HARRIS
Produced --,"'• 41:-•:"' t Prod d �� _ �,Y COMMISaION#FF997093
Nz�p�•, EXP RES May 30,2020 MI :.0e...,..,�
.07)398-0 .3a., Rod a otaryServite com o, EXPIRES Ma 30,2020
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(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED I
DATE 1
COMPLETED
Rev.8/2/17
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