HomeMy WebLinkAboutBuilding Permit Application i
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Permit Number:
Date: 11/22/2021 a RECEIVED
K;zl)0 NOV 12 2021
a5, ° j° BuildingPermit Application St.Lucie County
pp Permitting
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
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PERMIT APPLICATION FOR: Re-Roof
,PROPOSED IMPROVEMENT LOCATION ,
Address: 5000 Evergreen AVE Fort Pierce, FL 34947 f
Property Tax ID#: 2406-502-0125-000-5 I Lot No.
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Site Plan Name: I Block No.
Project Name: Re-Roof
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DETAILED DESCRIPTION OF WORK ` Ij I Jn
ReRoof(Remove old shingles and install shingles)
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New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION
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Additional work to be performed under this permit—check all that apply: d
_Mechanical _Gas Tank —Gas Piping _Shutters _Windows/Doors _Pond
Electric _Plumbing _Sprinklers _Generator 0 Roof 4/12 Pitch
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Total Sq. Ft of Construction: 2,310 Sq. Ft.of First Floor: 2,310 j
Cost of Construction:$ 13,500.00 Utilities: _Sewer _Septic Building Height: 10'
OWNER/LESSEE ,. CONTRACTOR4j �<
Name Alex R Seymour Name:Roderick Waller
Address:5000 Evergreen Ave Company:Sunrise City CHDO Inc
City: Fort Pierce State: FL Address: 130 S Indian River Drive Suite 202
Zip Code: 34947 Fax: City: Fort Pierce State:FL
Phone No.N/A Zip Code: 34950 Fax: 772-907-0420
E-Mail:N/A Phone No 772-201-2850 f
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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
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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.
SUPPLEMENTAL;CO.NSTRUCTION LIEN LAW INFORMATIQN
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DESIGNER/ENGINEER: L✓J Not Applicable MORTGAGE COMPANY: td Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone: I
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FEE SIMPLE TITLE HOLDER: ✓Q Not Applicable BONDING COMPANY: 1 ✓ Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
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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.
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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 m°ay restrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions Iwhich 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. 11
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 playing 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 Ow er/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 11 day of November .20 21 by Roderick Waller
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Name of person making statement.
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Personally Known X OR Produced Identification
T pe of Identification Produced
(Signature of Notary Public-State of Florida)
A OW xonry Pubhe Stem ak
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Commission No. (Seal) Ede
My Commiulon GO 9132M
Vat; Exp1m 09115r2023
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW R1EVIEW REVIEW
DATE 1
RECEIVED
DATE
COMPLETED
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