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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED J L7
01/31/2019 �/' ��/
Date: Permit Numb
""' ECEI'VED
JAN 3 12019
` Building Permit Application
Planning and Development Services Permitting Department
Building and Code Regulation Division St. Lucie County, FL
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial X Residential
PERMIT TYPE: Demolition
PaROPOSED INY?ROVEMENT LOCATION
Address: 3001 N US Hwy 1 Fort Pierce FL 34950
Prop Y ert Tax ID#: 1428-501-0084-000-7 Lot No. 16
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION ,QF WORK
.r
Demo the overhang on the North side of the building
NOTE: This project requires NO ELECTRICAL and NO PLUMBING.
CONSTRUCTI N INaF�ORIyIgTION
Additional work to be performed under this permit–check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor: 780
Cost of Construction:$ $1,500.00 Utilities: —Sewer —septic Building Height: 11
�1NNER/LESSEE ONTRA
�" CCTOR'
Name A and D Holding Group LLC, Name: Roderick Waller
Address: 14359 N 78th N PL Company: Sunrise City C. H. D. O. Inc.
City: Loxahatchee State: Address: 130 S. Indian River Dr.#202
Zip Code: 33470 Fax: City: Fort Pierce State: FL
Phone No. Zip Code: 34950 Fax: 7729070420
E-Mail: Phone No 772-201-2850
Fill in fee simple Title Holder on next page(if different E-Mail Rodwallerl@gmaii.com
from the Owner listed above) State or County License CGC1515114
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
If value of HVAC is$7,500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTALCONSTRUCTION LIEN ,LAW INFORII/IATION r
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _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 thepermit 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.
Signature of Owner/Lessee/ ontractor as Agent for Owner Signature of Contracto License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF St.Lucie COUNTY OF St.Lucie
The forgoing instrument was acknowledgedbefore me The forgoing instrument was acknowledged before me
this 31st day of January 201 q by this 31st day of January ,20-d by
Name of person'making statement. Name of person making statement.
StatePersonally Known X `� t Pu w crib Florida
;` spiug ntification Personally Know
Type of Identificatii ' MY Commission GG 238873 Type of IdentificR—ONotary Public State of Florida
Produced �ar Expiresos/3a202o Prod edSophia Harris238873
Expires 05/3012020
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(Signature of Notary Public-State of Florida) (S1:gna_t_u_rueVbf Notary Public-State of Florida)
Commission No. (Seal) Commission No. (Seal)
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