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ALL APPLICABLE INFO MUST BE
Date:
:D FOR APPLICATION TO BE ACCEPTED
SCANNED Permit Number:
BY
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Building Permit Application 'IN.0'J 2018
Planning and Development Services
Building and Code Regulation Division PenInitting pe
2300 Virginia Avenue, Fort Pierce FL 34982 St.Lucle Coin Y®nt
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential X
PERMIT APPLICATION FOR: Rnnf
Address: 3113 Avenue R Fort Pierce, FL 34947
1
Legal Description: SUNRISE PARK NO 1 BLK 5 LOTS 9 AND10 (0.34 AC) (OR 3599-627)
Property Tax ID #: 2405-501-0100-000-8
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
Tear off old shingles and install 5v Metal
Lot No.
Block No.
Additional work to be ertormed under this permit— cnecK all apply:
11HVAC GaslTank []Gas Piping _ Shutters Windows/Doors
Electric Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: 2662 S . Ft. of First Floor: 2662
t
Cost of Construction: $ 760'0.00 Utilities: _ Sewer 0 Septic Building Height:
�OWEIJLESS�E.
_
CONI"RACTC}R
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Name Mary Washington
Name: Roderick Waller
Address: 3113 Avenue R l
Company: Sunrise City CHDO Inc.
Address: 130 S Indian River Drive
City: Fort Pierce State: FIL
Zip Code: 34947 Fax:
City: Fort Pierce State: FL
Phone No.
34950 772-907-0420
Fax
Zip Code: :
Phone No. 772-201-2850
E-Mail:
Fill in fee simple Title IHolder on next page ('if different
E-Mail: rodwaller1@gmail.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.
I
5UppL'EMNTAL CCN5TRUCTICiN LIB}N LAIN {NFORMAT{ON'�
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DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY:
Q Not Applicable
Name: Mary Washington !
Name:
Add ress: 3113 Avenue R Fort Pierce, FL 34947 I
Address: 3113 Avenue R
City:
Zip: Phone:
State:
City: Fort Pierce State:
Zip: Phone
I
FEE SIMPLE TITLE HOLDER: 0 Not Applicable
BONDING COMPANY:
F71 Not Applicable
Name:
Name:
Address: I
Address:
City:
City: I
Zip: Phone:
Zip: Phone: I
I
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 tha41s 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 your Notice of Commencement.,,
Sign
STATE OF FLORIDA
COUNTY OF St Lucie i
Owner
The forgoing instrument was acknowledged before me
this3h_ day of 11W , 20 18 by
Name of person making
Personally Known X OR P
Tvne of Identification
nt
Identification
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF St Lucie County
The forgoing instrument was acknowledged before me
thisl9th day of^r 20 18 by
Roderick Waller
Name of person making statement
Personally Known X OR Produced Identification
Type of Identification
Produced
(Signature of N- tate of Florida )
Pfr.=
SOPHIA ISE
Commission NoiEli .
EXPIRES May 30, 2020
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DATE
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DATE
COMPLETED
Rev. 8/2/17