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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 01/13/22 Permit Number:
91ro(T ucm . RECEIVED
o o --- JAN IA 2022
Building Permit Application St.Lucie County
Planning and Development Services Permitting
Building and Code Regulation Division Commercial Residential X
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax: (772)462-1578
PERMIT APPLICATION FOR: Re-Roof- tk, - Coac cq�
PjR7P0`SEL? 111JPROVEM EDIT LOCATIC3N. a u z a
Address: 4501 AVENUE Q Fort Pierce, FL 34947
Property Tax ID#: 2406-131-0001-020-8 Lot No.
Site Plan Name: Block No.
Project Name: Re-Roof
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DE�AILEDDE��CRIPTION"�?F WORK �� � � ��
„�'�' ,.x a+h�Cg .,ns. �7.�'� y:'� �'.<b,.'��` '� 1 .y�£ 7"C7�d r,,•., � tt d%✓ d,„fah '�
After the fact Re-Roof Shingle to Shingle Owens Corning
New Electrical Meter Second Electrical Meter
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CaNSTRUCTION INFfORMATIO,N kr
e,
Additional work to be performed under this permit—check all that apply:
_Mechanical _Gas Tank —Gas Piping _Shutters Windows%Doors _Pond
Electric _Plumbing _Sprinklers _Generator Z Roof! 3/12 Pitch
Total Sq. Ft of Construction: 2,336 Sq. Ft. of First Floor:
Cost of Construction:$ 7,400.00 Utilities: _Sewer _Septic Buill ing Height: 8
ONER/LESSEE, y s` v CONTRACTQR
W h " x
Name SIMEL JEFFERSON Name:Roderick Waller
Address:2001 N 49th ST 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. Zip Code: 34950 Fax: 772-907-0420
E-Mail: Phone No 772-201 12850
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 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
I, ; ` �,t�g �✓ }._._a� 2.. sy. :, �� �,ue 2, ,Y RM 1T1� ^NfC �
i F DESIGNER/ENGINEER: Q Not Applicable MORTGAGE COMPANY: ? ✓[� Not Applicable
Name: N/A Name:N/A
Address: Address:
City: State: City: l State:
Zip: Phone Zip: Phone: 3
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FEE SIMPLE TITLE HOLDER: a Not Applicable BONDING COMPANY: E_Not Applicable
Name:N/A Name:N/A
Address: Address: it
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.
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 anothe 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.
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Signature of Ow er/Lessee/Contractor as Agent for Owner Signature of Contr ctor/License Hodder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF St Lucie COUNTY OF St Lucie
Sworn to(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of
E Physical Presence or Online Notarization E Physical Presence or Online Notarization
this 13th day of January 2021 by this 13th day of January ,2021 by
Roderick Waller Roderick Waller
Name of person making statement. Name of person making statement:
Personally Known OR Produced Identification Personally Known :[ OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Commission No. A 04 A 04 Commission No. Nowry
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COUNTE EVIEW REVIEW REVIEW REVIEW
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