HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �{ q
Date: �a l �� Permit Number:
En
EIVED
B,uiijdan�Rtermit Applicati11 2018
wing
Planning and Development Services untyt f3�y -.rm^ it
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential X
PERMIT APPLICATION FOR: Roof
PROPOSED IMI: OVEMENT LOCATibN
Address: 7203 DONLON RD, Fort Pierce FL
Legal Description: LAKEWOOD PARK -UNIT 11- BLK 143 LOT 30 (MAP 13/12N) (OR 836-1197)
Property Tax ID #: 1301-613-0145-000-7
Site Plan Name:
Project Name:
Setbacks Front Back: _
Remove and Replace Sq Flat Section
_ Right Side:
Left Side:
Lot No.
Block No.
11HVAC I— Gas Tank Gas Piping LJShutters ❑ Windows/Doors
❑ Electric ❑ Plumbing Sprinklers M Generator W1 Roof Roof pitch
Total Sq. Ft of Construction: goo S . Ft. of First Floor: � 5o�,.
,0 0 , 00 Utilities:Sewer E]Septic Building Height:
Cost of Construction: $ `9§ Q' /�
01NNER/LESSEE
. .°.
t CONTRACTOR y
Name Cynthia L Shinn
Name: Roderick Waller
Address: 7203 Donlon Rd
City: Fort Pierce State: FL
Zip Code: 34951 Fax:
Phone No.
Company: Sunrise City CHDO Inc.
Address: 3550 Okeechobee Rd
City: Fort Pierce State: FL
Zip Code: 34947 Fax: 772-907-0420
Phone No. 772-201-2850
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail: rodwallerl@gmaii.com
State or County License: CCC1327208
it value of construction is 5Z5UU or more, a RECORDED Notice of Commencement is required.
SUPPLEMEtVTAL CONSTRUCTION LIEN
LAW INFORMATIC?N
DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY: Q Not Applicable
Na me: Cynthia L Shinn
Name:
Address: 7203 DONLON RD, Fort Pierce FL
Address: 7203 Donlon Rd
City: Fort Pierce State"
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: 0 Not Applicable
BONDING COMPANY: allot 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 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 our Notice of Commencement.
Sign ture of Owner/ ssee/Contractor as Agent for Owner
Signature of Cont actor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF St Lucie County
COUNTY OF St Lucie County
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this 11th day of April 20 18 by
this 11th day of April 20 18 by
Roderick Waller
Roderick Waller
Name of person making statement
Name of person making statement
Personally Known X OR Produced Identification
Personally Known X OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature f Notary Public- State of Florida
Commission �rpLQ`f'= SOPHIA H 1�1RpRaI
ISSION FFro 7093
y,, �.,;
'??'aYk;` EXPIRES May 30, 2020
1(40?")'39M153 FloridallotaryService.com
(Signature of Is
OPHI
Commission o /�YPu SOMMISSiON j�9 p93
.? EXPIRES May 30, 2020
(407)399At53 FloridalloteryService.com
REVIEWS FRONT ZONING SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER REVIEW REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17