HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED IInnr-1
Date: Permit Number:
_... _
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 IIVIPROVEMENTLOCATION..
(Address: 6016 Spruce Dr Fort Pierce, FL 34982
Legal Description: INDIAN RIVER ESTATES -UNIT 09- BLK 85 LOT 13 (MAP 34112S) (OR 446-843)
Property Tax ID #: 3402-610-0437-000-8
Site Plan Name:
Project Name: RE -Roof
Setbacks Front Back:
Right Side: Left Side:
DETAILED DESCRIPTION OFyWORK " 4
.Y° :aqv
(remove old shingles and install new shingles) Product approvals
Lot No.
Block No.
Haanionai worK to De errormea under tnls permit— check all apply:
EIHVAC _ Gas Tank []Gas Piping _ Shutters ❑ Windows/Doors
Electric 0 Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: 2720 S Ft. of First Floor: 2720
Cost of Construction: $ 8,000.00 Utilities:n Sewer OSeptic Building Height: 8
OWNER/LESSEE
CONTRACTOR
Name Kurt Ellmers
Name: Roderick Waller
Address: 6016 Spruce Dr
Company: Sunrise City CHDO Inc.
Address: 103 S Indian River Drive, suite 202
City: Fort Pierce State: FL
City: Fort Pierce State: FL
Z'ip Code: 34982 Fax,
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: rodwallerl@gmail.com
from the Owner listed above)
State or County License: CGC1515114
IIt value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
W
N
ORNIATI®,N
DESIGNER/ENGINEER:
Q Not Applicable
MORTGAGE COMPANY: Q Not Applicable
Name:
Name:
Address:
Address:
City: State:
City:
State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
0 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 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 vour Notice of Commencement.
C
Signature of Owner/ Less a/Contractor as Age -for Owner
Signa ure of Con Iactor/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 19th day of July 2019 by
this 19th day of July 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
(Signature of Notary ublic- State of Florida)
(Signature of Not y Public- State of Florida )
Commission No. (Seal)
Commission No S I)
;w Notary Public State of Florida
Notary Public Stele of Florida
$ Sophia Harris
My Commissi
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tev. 8/2/17