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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED (,
Date: 06/15/2021 Permit Number:
.E U RECEIVED
�p ° JUN 18 2021
Building Permit Application St.Lude County
Planning and Development Services Permitting
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
PROPOSED IMP,R01/EMENT LUCATIC}N3` 3 „SEE
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Address: 5013 East Wood Dr, Fort Pierce, FL,34951
Property Tax ID#: 1301-615-0117-000-8 Lot No.
Site Plan Name: Block No.
Project Name: Re-Roof
DAETACLED QESCRIPTIONF W(3ERK; a�
ReRoof(Remove old shingles and install shingles):Shakewood (Timberline) NOA: 18-0409.06 Felt/NOA No.: 19-0312.04
New Electrical Meter Second Electrical Meter
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CQJSTRUCTION INFORMATION
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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 Z Roof 4/12 Pitch
Total Sq. Ft of.Construction: 24 Sq. Ft. of First Floor: 1,560
Cost of Construction:$ 4,100 Utilities: _Sewer _Septic Building Height:
Or1NNERjLESSEE CONTRAC�fOR�' _
Name J and D PMS LLC Name:Roderick Waller
Address:483 SW Lakota Ave Company:Sunrise City CHDO Inc.
City: Port St Lucie State: FL Address:130 S Indian River Drive Suite 202
Zip Code: 34953 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.
If value of HAVC is$7,500 or more,a RECORDED Notice of Commencement is required.
S�uPPLEMNTIC�ONSTC�TIQN IIEN l.A1N lN�QRMATI�Ns
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: ✓ZNot 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 attorney before commencing work oLrecording your Notice of Commencement.
Signature of Own r/Lessee/Contractor as Agent for Owner Signature of Contr ctor/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
E✓ Physical Presence or Online Notarization ✓0 Physical Presence or Online Notarization
this 15th day of June 2021 by this 15th day of June 2021 by
Roderick Waller Roderick Waller
Name of person making statement. Name of person making statement.
Personally Known�_OR Produced Identification Personally Known EZI OR Produced Identification
Type of Identification Type of Identification
Produced Produced
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(Signature of Notary Public-State of Florida) (Signature of Notary Pu ' - ,i,a_)——w
Notaryr Public Stem of Rc�tEt1
Commission No. E N .afb6d� Commission No. r E&H al)
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