HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 12/27/2021 Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: Re -Roof
PROPOSED IMPROVEMENT LOCATION:
Address: 8505 Penny LN Fort Pierce, FL 34951
Residential X
Property Tax ID #: 1301-608-0229-000-4 Lot No.
Site Plan Name: Block No.
Project Name: Re -Roof
DETAILED DESCRIPTION OF WORK:
ReRoof (Remove old shingles and install 5v Metal) Underlayment FL2569 / 5v Metal FL17796
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:
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: 1,839
Cost of Construction: $ 8,000.00
Sprinklers
Generator 0 Roof 4/12
Sq. Ft. of First Floor: 1,839
Pitch
Utilities: _ Sewer _ Septic Building Height: 10,
OWNER/LESSEE:
CONTRACTOR:
Name Kimberly K Campbell
Name: Roderick Waller
Address: 8505 Penny Ln
Company: Sunrise City CHDO Inc
City: Fort Pierce State: FL
Zip Code: 34951 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: N/A
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail rodwallerl@gmail.com
—
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: LLL Not Applicable
Name:
MORTGAGE COMPANY:
Name:
L✓J Not Applicable
Address:
Address:
_
City: State:
Zip: Phone
City:
Zip: Phone:
_State:
FEE SIMPLE TITLE HOLDER: II Not Applicable
Name:
BONDING COMPANY:
Name:
F71Not Applicable
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 attornev before commencing work or recording vour Notice of Commencement.
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Signature of Owner/ 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 27th day of December , 20 21 by Roderick Waller
Name of person making statement.
Personally Known X OR Produced Identification
Type of Identification Produced
(Signature of Notary Public- State of Florida )
Commission No. (Seal)
REVIEWS FRONT
COUNTER
DATE
RECEIVED
DATE
COMPLETED
ev 5 20 21
ZONING
REVIEW
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% Nmry Pubk Slaw of Florida
Eric Harrell
My Cammiaaion GG 413260
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SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
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