HomeMy WebLinkAboutBuilding Permit Application v
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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 02/01/2019 Permit Number
9 �M . KU; Q
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Building Permit Application
FEB _ 2019
Planning and Development Services Permitting Department
Building and Code Regulation Division St. Lucie Count FL
2300 Virginia Avenue,Fort Pierce FL 34982 r
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residentia
PERMIT APPLICATION FOR: Roof
PROPOSED IMPROVEMENT LOCATION
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Address: 2001 N 41st Street, Fort Pierce, FL
Legal Description: 6 35 40 THAT PART OF NE 1/4 OF NE 1/4 LYG SELY OF N EMERGENCY RELIEF CANAL R/1
THCONT N 404.29 FT, TH S 46 DEG SEC 27 W 480 FT M/L TO PT W OF POB TH E 460 FT M/L TO POB (1) (2.
Property Tax ID#: 2406-111-0003-000-4 Lot No.
Site Plan Name: Block No.
Project Name: RE - ROOF
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK .
r
e r RE-ROOF SHINGLE TO SHINGLE UNDERLAYMENT: PEEL&STICK
CONSTR'UCTI'ON INF.,ORM, ION
Additional work to be nertormed under this permit—c ec a appy:
HVAC Gas Tank Gas Piping _Shutters Windows Doors
❑ P g ❑Windows/
Doors
0 Plumbing Sprinklers Generator Roof 312 Roof pitch
Total Sq. Ft of Construction: 2,754 S . Ft.of First Floor: 2,754
Cost of Construction:$ 8,350.00 Utilities:Cn Sewer E]Septic Building Height: 11
OVI1IVER/LESSEE ' CONTRACTOR ,f
. LAWRANCE C. SALTER
Name RODERICKJ Name: WALLLER
Address: 260 CHAMPAGNE CT. Company: SUNRISE CITY C. H .D .O. INC.
City: FORT PIERCE State: FL Address: 130 S INDIAN RIVER DR. #202
Zip Code: 34950 Fax: City: FORT PIERCE State: FL
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$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTA ' CON$TR3UCTION LIEN LAW INFORMATION
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: 130 S INDIAN RIVER DR.#202 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.
LA OJ / I A)MA, U'i � r,v Lt'__
Signa u re'67 Owner Less,e/Contractor as Agent for Owner Signa ure of Contractor I
icense Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF ST.LUCIE COUNTY OF ST.LUCIE
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 1ST day Of FEBRUARY 20_ by this 1ST day Of FEBRUARY 20_ by
RODERICK J WALLER RODERICK J 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
Prod ed Prod
(Signature of Notary Public-State of Florida) (Signature 8f Notary Public-State of Florida)
Commission No. a Commission No.
otxry Public Stele of Florida 7epjW%_� Notary Public Stets of Florida
Sophia Harris ; Sophia Harris
My Commis3ion GG 238873 My Commission GG 238673
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REVIEWS APOR PLANS V E G VE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17