HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 2/18/19 Permit Number: l`vn-- &: 5
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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: "boor.
PR0OSED1MPROVEMENT LOCATION kd=- `
Address: 3308 Meadow Ln, Fort Pierce FL
Legal Description: 17 35 40 W 100 FT OF N 1/2 OF S 1/2 OF SE 1/4 OF NE 1/4 OF NW 1/4-LESS S 15 FT OF
E 75 FT-(134)(0.35 AC)(OR 444-2483)
Property Tax ID#: 2417-214-0004-000-1 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPF TION OWORK
1. e
2. Install new front door
CONSTRUCTION INFORMATION
Additional work to be performed under this permit—check all ma apply:
[IIHVAC _Gas Tank Gas Piping ]Shutters Q Windows/Doors
Electric 0 Plumbing Sprinklers [i Generator11 Roof Roof pitch
Total Sq. Ft of Construction: 2510 n'� Sc. Ft.of First Floor: 2510
Cost of Construction:$ 14f7C0O Utilities: _Sewer I nI Septic Building Height:
OWNER%LESS'EE x' CONTRACTOR r '`'
Name Annie L Moore Name: Roderick Waller
Address:3308 Meadow Ln Company: Sunrise City CHDO Inc.
City: Fort PierceState:F. Address: 130 S Indian River Drive
Zip Code: 34947 Fax: City: Fort Pierce State:FL
Phone No. Zip Code: 34950Fax: 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:•667g1:3,29Ibb C6-C/S/S1
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION
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DESIGNER/ENGINEER: E-Not Applicable MORTGAGE COMPANY: Q Not Applicable
Name:Annie L Moore Name:
Address:3308 Meadow Ln,Fort Pierce FL Address: 3308 Meadow Ln
City: Fort Pierce State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: IT 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 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 your Notice of Commencement.
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Signature of Owner/Less /Contractor as Agent for Owner Signature of Contractor/Lic nse 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 18th day of February ,20 19 by this 18th day of February ,20 19 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
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(Signature o Notary Public-State of Florida) (Signature of otary Public-State of Florida)
Commission No. Commission No. e;
yY eos Notary Public State of Florida :,-ry Public S :of Florida
Sophia Hams Sophia Hams
��1, k My Commission GG 238873 'Ji J My Commission GG 238873
1i w Elres 05/3012020 "1,,,,,o* Expires 05/30/2020
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DATE
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Rev.8/2/17