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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 01/11/2021 Permit Number:
RECEIVE®
11}Ib JAN 12 2022
Building Permit Application d g
St. Lucie County
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
Permitting
Residential 'X
PERMIT APPLICATION FOR: New Construction for a Single Family House
I,y Y
PROP �� SED IN
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Address: 5502 Winter Garden PKWY , Fort Pierce, FL 34982
Property Tax ID #: 1301-614-0080-000-6
Site Plan Name:
Project Name: New Single Family Home
CONSTRUCTION OF A NEW SINGLE FAMILY HOUSE
New Electrical Meter X Second Electrical Meter
(Affidavit required)
Lot No. 20
Block No. 159
Additional work to be performed under this permit— check all that apply:
✓QMechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors _ Pond
Q Electric F1 Plumbing _ Sprinklers _ Generator [ Roof 4/12 Pitch
Total Sq. Ft of Construction: 2262 Sq. Ft. of First Floor: 2262
Cost of Construction: $ 160,000.00 Utilities: —Sewer ._Septic Building Height: 12
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2 iS! 1 p 3}i h
ClC7NTRACTOR s ,
Name GHAZANFAI?AAEED_ -- -
Name: Roderick Waller
Address: 3706 PROMENADE WAY
Company: Sunrise City CHDO Inc
City: FORT PIERCE State: FL
Address: 130 S Indian River Drive Suite 202
Zip Code: 34982 Fax:
City: Fort Pierce State: FL
Phone No. N/A
Zip Code: 34950 Fax: 772-907-0420
E-Mail: N/A
Phone No 772-201-2850
E-Mail rodwaller1 @gmail.com
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
State or County License CCC1515114 Q q�
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.
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DESIGNEIIR/ENGINEER: LJ Not Applicable
MORTGAGE COMPANY: F/I Not Applicable��
Name: TgDD N. SMITH
Name:
Address Is,a 20TH PLACE
Address:
City: VERO BEACH State: FL
City: State:
Zip:32964 Phone
I
Zip: Phone:
FEE SIMPLE TITLE HOLDER: II✓ Not Applicable
BONDING COMPANY: JZNot 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.
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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 11th day of JANUARY 20 21 by Roderick Waller
Name of person making statement.
Personally Known X OR Produced Identification
ype of Identification Produced.
(Signature of Notary Public- State of Florida )
W No".Pubia SUM Fbr s
Commission No. (Seal) l EdcHemell
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