HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED f�
Date: �• • % �• Permit Number,v�
RECEIVED
Building Permit Application JAN 16 2019
Planning and Development Services
Building and Code Regulation Division Permitting Department
2300 Virginia Avenue, Fort Pierce FL 34982 X S U i e County, FL
Phone: (772) 462-1553 Fax: (772) 462-1578 COI' mercial
PERMIT APPLICATION FOR: Renovation
Address: 8611 S. U S HWY 1, PROT ST. LUCIE FL 34982 ( Yb q- 3 i,1S J+
Legal Description: ST. LUCIE GARDENS 26, 36, 40 BLK 3 LOTS 12, 13, 14, & 15.
Property Tax ID #: 3414-501-1912-500-6 Lot No.
Site Plan Name: Block No. 3
Project Name: _ eUe- S L—
Setbacks Front Back: Right Side: Left Side:
Bathroom Renovations
11HVAC _
Electric Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: C6 ,55D S . Ft. of First Floor:
Cost of Construction: $ 14��(� Utilities:nSewer OSeptic Building Height:
W)lzt-17
MLlwm 9 ►.J
"Shutters
11 Windows/Doors
Roof pitch
RCONTRACTOR
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Name Crowne St. Lucie Associates LP
Name: RODERICK J WALLLER
Company: SUNRISE CITY C. H.D.O. INC.
Address: 130 S INDIAN RIVER DR. #202
Address: 1015 Financial Center
City: Birmingham State: AL
Zip Code: 35203 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: CGC1515114/CCC1327208
It value of construction is $Z500 or more, a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name: � wi
Name:
Address: , ._ Z'd ®,o— 2 3
Address:
City: State:
city: State:
Zip: Phone 2&3•— 5e,— *2Z!
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
Address: 130 S INDIAN RIVER DR. #202
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
commencinR work or recording our Notice of Commencement.
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Signature n r/ Lessee/Contractor as Agent for Owner
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Signature of Contrac r/License 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 15TH day of January 20_ by
this 15TH day of January 20_ by
RODERICK J WALLER
RODERICK J WALLER
Name of person making staf
Name of person making statement
Personally Kn F. c c p do
Personally Known X OR I I • • •
Ok
Type of Identi a �ry PubNc
,Q Sophia Hams
GG 23g873
Type of Identific I
Notary Public State of Fbride
Produced `��
Produced micsbn
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Expiraa 05r=uzu
or a
My Commi��ssw�n GG 23e873
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(Signature of Notary Public- State of Florida)
(Signature of otary Public- State of Florida )
Commission No. 05/30/2020 (Seal)
Commission No. 05/30/2020 (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
a II II
DATE
COMPLETED
Rev. 8/2/17