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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED /�
Date: 10/25/2021 Permit Number:
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' Building Permit Application OCT 2 5 2021
Planning and Development Services St. Lucie County
Building and Code Regulation Division Commercial Residential x Permittinc
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: StUCCO
PROPOSED IMPROVEMENT LOCATION:
Address: 2849 Harson Way Fort Pierce FL
Property Tax ID #: 1428-702-1354-000-5
Site Plan Name:
Project Name: Stucco
DETAILED DESCRIPTION OF WORK:
Stucco Exterior of house
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION.^t , ,--0 Q
Lot No._
Block No.
Additional work to be performed under this permit— check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters ❑Windows/Doors _ Pond
Electric _ Plumbing
Total Sq. Ft of Construction: 2,306
Cost of Construction: $ 1850.00
_ Sprinklers
_ Generator ❑. Roof
Sq. Ft. of First Floor: 2,306
Pitch
Utilities: —Sewer _ Septic Building Height: 10'
OWNER/LESSEE:
CONTRACTOR:
Name John Phillips
Name: Roderick Waller
Address: 9161 159th CT N
Company: Sunrise City CHDO Inc
Address: 130 S Indian River Drive Suite 202
City: Jupiter State: FL
Zip Code: 33478 Fax:
Phone No. 305-336-8139
City: Fort Pierce State: FL
Zip Code: 34950 Fax: 772-907-0420
Phone No 772-201-2850
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail rodwaller1 @gmail.com
State or County License CGC1515114
IT Value oT construction is ZWU 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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: IL Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: ID 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 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 or recording our Notice of Commencement.
Signature of Owne / Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF St Lucie
Sworn to (or affirmed) and subscribed before me of X Physical Presence or Online Notarization
this 25th day of October 2o21 by
Name of person making statement.
Personally Known OR Produced Identification X
Ty of Identification Produced FL DL
(Signature of Notary Public- State of Florida )
uewy Polio ew. a Pa
Commission No. (Seal) . Ede Hwml
My Ca"Mitsim GO 913209
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