HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED I I r 6 ZZ
Date: 12/07/2021 Permit Number.
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential A•���m�n9 �
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: Re -Roof
PROPOSED IMPROVEMENT LOCATION:
Address: 4911 Eagle DR , Fort Pierce, FL 34950
Property Tax ID #: 1312-801-0051-000-2
Site Plan Name:
Project Name:
Re -Roof
DETAILED DESCRIPTION OF WORK:
Re -Roof (Remove old shingles and install New shingles)
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:
Lot No. 248
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 _ Sprinklers
Total Sq. Ft of Construction: 5,923
Cost of Construction: $ 20,000.00
_ Generator IL Roof 4/12
Sq. Ft. of First Floor: 5,923
Pitch
Utilities: _ Sewer _ Septic Building Height: 12
OWNERAESSEE:
CONTRACTOR:
Name Ancel Brown
Name: Roderick Waller
Address:4911 Eagle DR
Company: Sunrise City CHDO Inc
City: Fort Pierce State: FL
Zip Code: 34950 Fax:
Phone No. N/A
Address: 130 S Indian River Drive Suite 202
City: Fort Pierce State: FL
Zip Code: 34950 Fax: 772-907-0420
Phone No 772-201-2850
E-Mail rodwaller1@gmail.com
E-Mail: N/A
Fill in fee simple Title Holder on next page ( if different
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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: ✓ Not Applicable
MORTGAGE COMPANY: LZI Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: II 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.
p6Aa,-A J Lo Oj�
Signature of Owner/ Lessee/C ntractor 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 7TH day of December , 20 21 by Roderick Waller
Name of person making statement.
Personally Known X OR Produced Identification
T�f tification Produced
(Signature of Notary Public- State of Florida) WWV�M
IioN1y P-W "w- d florid
Commission No. (Seal) ErtcHanN
KXPAGO St
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 5/20/21