HomeMy WebLinkAboutBuilding Permit ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED / 0
Date: Permit Number:
Building Permit Applicationy ZJ
Planning and Development Services
Building and Code Regulation Division P "ting DQ
1300 Virginia Avenue, Fort Pierce FL 34981 S���le County
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential X
PERMIT APPLICATION FOR: Demolition
PROPOSED IMPROVEMENT LOCATION:
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#: 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:
Demo Shed C,U.,,�de^ aN(30)
CONSTRUCTION INFORMATION:
Additional work to be performed under t ispermit—check all appy:
HVAC Gas Tank E]Gas Piping Shutters ❑Windows/Doors
Electric ❑ Plumbing Sprinklers ❑Generator Roof Roof pitch
Total Sq. Ft of Construction: 5ft Sq. Ft. of First Floor: AM a00
Cost of Construction: $ yo Utilities:Sewer D 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 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: GGG132a-08
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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: ✓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
commencing work or recording our Notice of Commencement.
Ltn� CN,I�' W,4 L )02A
Signatur of Owner/Le see/Contractor as Agent for wner Signature of Contracto f
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 21th day of June 20 18 by this 21th 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 Type of Identification
Produced Produced
(Signatu "„tee„-Flewla (Signature of
5Y'„ SOPHIA HARRIS �'"T'° SOPHIA HARRIS
Commiss 'R ION#1`499 093 Commission N MY COMMISSION(>6Rf 1b7093
M—aliF EXPIRES May 30,2020 '.'+o.i:,, EXPIRES May 30,2020
1!2L298-0153 FlonAeNotaryServa;e.com (407)398-0153 FlondallotarySerwce.com
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17