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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 03/16/21 Permit Number:
r, T Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential X
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax:(772)462-1578
PERMIT APPLICATION FOR: Re-Roof
Address: 3603 Promenade Way, Fort Pierce, FL,34982
Property Tax ID#: 2433-502-0050-000-2 Lot No.
Site Plan Name: Block No.
Project Name: Re-roof
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Remove old shingles and install 5v metal/FL17022-Underlayment FL16048
New Electrical Meter Second Electrical Meter
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Additional work to be performed under this permit—check all that apply:
_Mechanical _Gas Tank —Gas Piping _Shutters _Windows/Doors _Pond
_Electric _Plumbing _Sprinklers _Generator W1 Roof 4/12 Pitch
Total Sq. Ft of Construction: 1,534 Sq. Ft. of First Floor: 1,534
Cost of Construction:$ 17,500 Utilities: —Sewer —Septic Building Height:
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Name David Lamos Name:Roderick Waller
Address:805 Delaware Ave Company:Sunrise City CHDO Inc.
City: Fort Pierce State: FL Address:130 S Indian River Drive Suite 202
Zip Code: 34950 Fax: City: Fort Pierce State:FL
Phone No.(772)940-8525 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 CCC1327208
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
If value of HAVC is$7,500 or more,a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER: ✓Q Not Applicable. MORTGAGE COMPANY: ✓�Not Applicable
Name:N/A Name:N/A
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: ✓ Not Applicable BONDING COMPANY: ✓ Not Applicable
Name:N/A Name:N/A
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 paying twice for
improvements to your property.A Notice of Commencement must be recorded in the public records of St.
Lucie County and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
with lender or an attorne .before commencingwork or_record in our_Notice of Commencement.
Signature of Ow er/Lessee/Contractor as Agent for Owner Signature of Con actor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF St Lucie County COUNTY OF St Lucie County
Sworn to(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of
✓] Physical Presence or Online Notarization ❑✓ Physical Presence or Online Notarization
this 12th day of April 2021 by this 12th day of April ,2021 by
Roderick Waller Roderick Waller
Name of person making statement. Name of person making statement.
Personally Known 0_OR Produced Identification Personally Known�_OR Produced Identification
Type of Identification Type of Identification
R 7 duced Produced
(Signature of Notary Publ '(Signature of Notar
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Commission No. EdcH�ute#
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REVIEWS FRONT ZONING; SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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