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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Q
Date: 2/4/2017 Permit Number: U'�
Building Permit Application AUG 2 2 2017
Planning and Development Services PFRi1,11-TING
Building and Code Regulation Division St. Lucie County, FL
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential X
PERMIT APPLICATION FOR: Roof
PROPOSED I'IVhFRO. E M 6 N T LOCATION
Address: 7505 SANTA CLARA BLVD, Fort Pierce FL 34946
Legal Description: LAKEWOOD PARK -UNIT 7- ELK 71 LOT22 (MAP 13/02N) (OR 2934-2701; 3387-2949)
Property Tax ID #: 1301-607-0050-000-5
Site Plan Name:
Project Name:
Setbacks Front Back:
Right Side: Left Side:
Re -Roof - Tear off and replace shingles / Tear off and Replace Flat section
Vl J -.7,
E1HVAC Ll Gas Tank
11 Electric 0 Plumbing
Total Sq. Ft of Construction: 1860
Cost of Construction: $ 6600
Lot No.
Block No.
unaer tnis permit — cnecK all apply:
[]Gas Piping _ Shutters a Windows/Doors
11 Sprinklers Generator W] Roof
S Ft. of First Floor: 1860
Utilities: Sewer []Septic Building Height: _
<:CONTRrACTOR `b
;OWNER/LESSEES
V�
r.
Name 7505 Santa Clara Blvd Land Trust
Name: Roderick Waller
Company: Sunrise City CHDO, Inc.
Address: 7050 W Palmetto Park RD Ste 15-675
City: Boca Raton State: FL
Address: 3550 Okeechobee Rd
City: Fort Pierce State: FL
Zip Code: 33433 Fax:
` r
Phone No. J 1 0 13 �t
Zip Code: 34947 Fax: 772-907-0420
E-Mail:
Phone No. 772-201-2850
Fill in fee simple Title Holder on next page ( if different
E-Mail: rodwallerl@gmaii.com
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.
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S,UPPLEf_V�EI TALCONSTRUCT�O'N LIEN LAMIN@F®R,M
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DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY:
_ Not Applicable
Name:
Name:
Address:
Address:
City:
State:
City: State:
Zip: Phone:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY:
Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
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 your paying twice for
improvements to your property. A Notice of Commencement must be recorded 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 vour Notice of Commencement.
t Wd
_ Signature of Owner Lessee/Agent
STATE OF FLORIDA I
COUNTY OF act
The f r oing instru ent as acknowledged b fore me
thisday of 20 by
— �Y) 0�u C Wfil �J�
(Name of person acknowledging )
(Signature of Notary Public- State of Florida )
Personally Known I/ OR Produced Identification
Type of Identification roduced
Commission No.
PRYo4�i-
KAREN S. NIELSEN
;'4--
?
Commission ;k FF 115637
f
My Commission Expires
Revised 07/15/2014
` "° '
;,,«_
June 1 2, 201 a
re
STATE OF FLORIDA
rise hoioer
COUNTY OF :)a - ir'A )CII L-
The forgoing instr ent was acknowledged efore me
thiSoLokQrn of 20 by
(Name of person acknowledging)
(Signature of Notary Public- State of Florida )
Personally Known I/ OR Produced Identification
Type of Identification Produced
-Commission No. I� I��i�(Seal)
KAREN S. NIELSEN
My Commission Expires
June 12, 2018
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