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TALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
o RECEIVED
Building Permit Application SEP 12 1018
Planning and Development Services
Building and,Code Regulation Division Permitting Department
2300 Virginia Avenue,Fort Pierce FL 34982 St. Lucie County
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential X
PERMIT APPLICATION FOR: Roof
PROP OS'ED,IMPROVEMENT LOCATLON
Address: 7003 PASO ROBLES BLVD
i
Legal Description: LAKEWOOD PARK-UNIT 9-BLK 105 LOT 27 (MAP 13/01 N)(OR 314-2086)
Property Tax ID#: 1301-611-0105-000-9 Lot No.
Site Plan Name: Block No.
,Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED,DESCRIRTION OF WORK s
Roof over Shingles f D1) _ g a
G
C `NSTRUCTI ahN INFORMATION % 'x k T r cy� x
Additionalwork to be nertormed under tis permit—check all appy:
! OHVACGas Tank In
OGas Piping _Shutters Q Windows/Doors
Electric 0 Plumbing ❑Sprinklers I Generator W1 Roof 512 Roof pitch
(Total Sq. Ft of Construction: Sq. Ft. of First Floor: 1698
Cost of Construction:$ 2400.00 Utilities:Sewer 0 Septic Building Height:
'E
_14
s CONTRACTOR '.
h..
NamEy L. _'(�F} LL, A / R E Name: Roderick Waller
Address:7003 PASO ROBLES BLVD Company: Sunrise City CHDO Inc
City: Fort Pierce State:FL Address: 130 S Indian River Drive
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 License: CGC1515114/CCC1327208
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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SIiPPL'EMENTALCONrSTRUCTIONaLIEN LAW INFQRMATION ' r -k ,; Ge,, {air t
n
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Q Not Applicable
N am e:Marcus L Dixon Name:
Address:7003 PASO ROBLES BLVD Address: 7003 PASO ROBLES BLVD
City: Fort Pierce State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: 0 Not Applicable BONDING COMPANY: ✓ LNot 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.
i Signatu a of Owner/Less /Contractor as Agent for Owner Signature of Contractor/Lic nse Holder
STATE OF FLORIDA �1 ` STATE OF FLORIDA
COUNTY OF 0 1 � �11C��`� COUNTY OF S� �V�-f\�
The forgoing instrument was cknowledge efore me The for oing instrument was acknowledg fore me
this day of by this day of .S' .c� 20by
Name of person making statement Name of person making statement
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produce Produced
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
1 Commis Commission Na
U of Fltxt bY1�Sta1� 9
Sophia Hams
My Commission GG 230®73 �. f:or�tnisaion 2@�!7�.
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REVIE UPERVISOR PLANS VE A I A A GROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17