HomeMy WebLinkAboutBuilding Permit Application I
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 11/14/18 Permit Number: l eI 1''(:),( -7
GO o NT,b` t,
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
PROPOSED IMPROVEMENT LOCATION:
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Address: 3004 Anderson Dr, Fort Pierce, FL 34946
Legal Description: SHERATON PLAZA-UNIT FOUR REPLAT LOT 246 (OR 219-2550)
1432-807-0004-000-5
Property Tax ID#: Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
4 I f
DETAILED DESCRIPTION OF-1NORK
Remove & Replace Shingles FL2346-R7 underlayment, FL10124-R20 Shingles
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CONSTRUCTION INFORMATION: F ';._
Additional work to be performedunder this permit–check all;ha apply:
El HVAC Gas Tank flGasPi in 1Shutters nl Windows Doors
— I I Piping l�I /
❑Electric ❑ Plumbing ❑Sprinklers ri Generator I r( Roof 3/12 Roof pitch
Total Sq. Ft of Construction: 1582 S . Ft. of First Floor: 1582
Cost of Construction:$ 6330.00 Utilities: I _Sewer Septic Building Height:
OWNER/LESSEE "CONTRACTOR:
Name Margaret A Davis Name: Roderick Waller
Address:3004 Anderson Dr Company: Sunrise City CHDO Inc.
City: Fort Pierce State:FL Address: 130 S Indian River Drive
Zip Code: 34996 Fax: City: Fort Pierce State:FL i
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: 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.
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SUPPLEMENTAL COI\iSTR0CTION LIEN ,LAW,INFORMATION
G � ,n
DESIGNER/ENGINEER: Q Not Applicable MORTGAGE COMPANY: ✓L Not Applicable
Name:MargaretADavis Name:
Address:3004 Anderson Dr,Fort Pierce,FL 34946 Address: 3004 Anderson Dr
City: Fort Pierce State: City: State:
Zip: Phone Zip: Phone:
1
FEE SIMPLE TITLE HOLDER: 0 Not Applicable BONDING COMPANY: Not Applicable
Name: Name: I
Address: Address: I
City: City: I
Zip: Phone: Zip: Phone: 1
I
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. 1
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 1
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
commencin: work or recording your Notice of Commencement. ,
aL1 ' l (3 (4- i.
Si nature of Owner Lessee
/C/ /Contractor as Agent for Owner Signature of Contractor cense Holder
STATE OF FLORIDA / STATE OF FLORIDA
COUNTY OF St Lucie County COUNTY OF St Lucie County
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The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 14th day of November ,20 18 by this 14th day of November ,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
Produ Produ'-.
_.>.L.2 a , kii ..oixiv-- ,a____
I \ \__otiv
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(Signature of otary Public-State of Florida (Signature • Notary Public-State of Florida)
Commissi•• ev Notary aP sic Sta a of f(M Commissi r .
4,9 Sr
Al MyPCommission GG 238873 �ry.Public State of Florida:� � Sophia Harris
11, wr Expires 05/30/2020 I My Commission GG 238873
Expires I /30/20c0
REVIEWS FRONT ZONING SUPERVISOR PLANS V E A 01 'A''sd '- ANGRIOVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17