HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ____________________ Permit Number: _____________________
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial __________ Residential ___________
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding _________
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: __________________________________________________________________________________________
Property Tax ID #: _________________________________________________________________ Lot No.__________
Site Plan Name: __________________________________________________________________ Block No. _______
Project Name: ______________________________________________________________________________________
DETAILED DESCRIPTION OF WORK:
_________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
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 __ Sprinklers __ Generator ___ Roof __________ Pitch
Total Sq. Ft of Construction: ___________________ Sq. Ft. of First Floor: _________________________
Cost of Construction: $ _____________________ Utilities: __ Sewer __ Septic Building Height: __________
OWNER/LESSEE: CONTRACTOR:
Name__________________________________________
Address: ________________________________________
City: _________________________________ State: ___
Zip Code: ______________ Fax: ____________________
Phone No.______________________________________ E-
Mail:________________________________________
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Name: ________________________________________
Company: _____________________________________
Address: _______________________________________
City: ______________________________ State: ____
Zip Code: ________________ Fax: __________________
Phone No______________________________________
E-Mail_________________________________________
State or County License___________________________
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.
3/7/22
X
5221 Winter Garden Pkwy Fort Pierce FL 34946
1301-615-0042-000-1 21A/ 22A
168
Change of use
Change of use from Comm Neigh to Residential / Please find attached asbuilt plans
This application is to replace 1911-0291 and 2106-0660
2,355 2,355
1500.00 10
GREIT, LLC Roderick Waller
P. O. BOX 13175 Sunrise City Concrete Services Inc
FORT PIERCE 130 S. Indian River Dr. #202
34979 Fort Pierce FL
772-224-0095 34950 772-907-0420
772-201-2850
Rodwaller1@gmail.com
CGC1515114
FL
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: ___ Not Applicable
Name: _____________________________________
Address: __________________________________
City: __________________________ State: _____
Zip: ___________ Phone______________________
MORTGAGE COMPANY: ___ Not Applicable
Name: ____________________________________
Address: ___________________________________
City: ____________________________State: _____
Zip: __________ Phone: ______________________
FEE SIMPLE TITLE HOLDER: ___ Not Applicable
Name: _____________________________________
Address: ___________________________________
City: _______________________________________
Zip: ___________ Phone: ______________________
BONDING COMPANY: ___Not Applicable
Name: ____________________________________
Address: ______________________________________
City: __________________________________________
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 conflicts with any applicable Homeowners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Homeowners 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 your Notice of Commencement.
___________________________________________
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF_________________________________
Sworn to (or affirmed) and subscribed before me of ____ Physical Presence or _____ Online Notariz ation
this ____ day of _________________, 20___ by
Name of person making statement.
Personally Known _______ OR Produced Identification ______
Type of Identification Produced__________________________
(Signature of Notary Public- State of Florida)
Commission No. ______________ (Seal)
REVIEWS
FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR
REVIEW
PLANS
REVIEW
VEGETATION
REVIEW
SEA TURTLE
REVIEW
MANGROVE
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 5/20/21
Personally Known _______ OR Produ
Typepepepepepeeeeeeeeee of Identification Produced_____
(Si t f N t P bli St t f
______________________________________
Signature of Ownner/ Lessee/Contra
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Wayne Gandy
720 S Orange Blossom Trail
Orlando FL
32810
St Lucie
X7th
Roderick Waller
March
X
FL DL
GG913269
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