HomeMy WebLinkAboutBuilding Permit Application y
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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �( (�
Date: l0 I l'i. V 1 Permit Number: Lei 03??,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
PIR ,POSED,IMPROVEMENT LOCATION a - ,, ° , �il , `'M ,`r
Address: 4500 REDWOOD DR, Fort Pierce FL
Legal Description: HOLIDAY PINES S/D-PHASE III-LOT427 (MAP 13/12S) (OR 1359-2928)
Property Tax ID#: 1313-502-0004-000-3 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
' ',-40.4A.,
ETAILEDDESCRIPTION OF WORK --V.' 410
.. x ��o�n � _ s.uaid��ra�r_,e,•t ''d'*�. sfi��...
Roof Over with Shingles FL10626-R13
CbNSTRU TION INFORMATION - ,'' ';'1,'''' , ' d ' `°"lgt��
Additional work to be performed under this permit—check all hat apply:
[11HVAC n Gas Tank Gas Piping I Shutters Windows/Doors
_ 1.1
ElElectric 0 Plumbing Sprinklers _Generator 'Roof 7/12 Roof pitch
Total Sq. Ft of Construction: 1908 Sq. Ft. of First Floor: 1908
12,500
Cost of Construction:$ Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE '' ° � , iid� ��ONTRACTOR•: ., f x ,a kn�i4 .ga ;
Name David A Lehoullier Name: Roderick Waller
Address:4500 REDWOOD DR Company: Sunrise City CHDO Inc.
City: Fort Pierce State:FL Address: 130 S Indian River Drive Suite 202
Zip Code: 34951 .Fax: City: Fort Pierce State:FL
Phone No. I 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: rodwaller1@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 `
DESIGNER/ENGINEER: EL Not Applicable MORTGAGE COMPANY: ✓Q Not Applicable
Name:DavidALehoullier Name:
Address:4500 REDWOOD DR,Fort Pierce FL Address: 4500 REDWOOD DR
City: Fort Pierce State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: IT 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 thesubject structure
which is in contlisu
ct 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 your Notice of Commencement.
06-614"IL
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Signature o Owner/Le' see/Contractor as Agent for Owner Signature of Contracto 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 17th day of October ,20 18 by this 17th day of October ,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
(Signature o• ot. + .. - .-, . 1.'a (Signature o ,Notary Public-State of Florida)
*ware. Notary Public State of Florida - -
Commission No. • - • S �r 238873 Commission No. •' Notary PublicSte(�fk]
orkie
ore, .Expires 0513012020 • ;• • 'T'' Harris
My Commission GG 238873
No.Aa Expires 05/30/2020
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE -
RECEIVED
DATE
COMPLETED
Rev. 8/2/17