HomeMy WebLinkAboutBUILDING PERMIT APPLICATION,4`
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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCE - rED
Date: 6.7 1tl6� Permit Num �6 D%
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Building Permit Applicatio JUN 0 7 2018
Planning and Development Services Irmillin,Building and Code Regulation Division e partm ent
2300 Virginia Avenue, Fort Pierce FL 34982 . LUCi Cou nty, FL
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial lelt
PERMIT APPLICATION FOR: Roof
xPOPO5ED IMPRa'1(EMENT�LC?CATtG?N ' `
Address: 1702 BEHRENS RD, Fort Pierce FL
Legal Description. ANGLEVILLA BLK 1 SWLY 1/2 OF LOT4 AND ALL LOT 5 (0.21 AC) (OR 874-455; 2398-1003)
Property Tax ID #: 2406-504-0003-000-0
Site Plan Name:
Project Name:
Setbacks Front Back:
Re -Roof - F-t&T'
11 Electric 0 Plumbing
Total Sq. Ft of Construction: 1508
Cost of Construction: $ 4500.00
Right Side:
Sprinklers
Left Side:
11 Generator
S Ft. of First Floor: 1508
Utilities: Sewer 0 Septic
Lot No._
Block No.
❑✓1 Roof 3i'12 Roof pitch
Building Height:
au � . 1SS 4 FacaN-rRAc-roR
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Name Livingston Clark
Name: Roderick Waller
Address: 1702 Behrens Rd
Company: Sunrise City CHDO Inc.
City: Fort Pierce State: FL
Address: 1209 S Indian River Dr
City: Fort Pierce State: FL
Zip Code: 34947 Fax:
Phone No.
Zip Code: 34950 Fax: 772-907-0420
E-Mail:
Phone No. 772-201-2850
Fill in fee simple Title Holder on next page ( if different
E-Mail: rodwaller1@gmail.com
from the Owner listed above)
State or County License: CCC1327208
it value of construction is SZ500 or more, a RECORDED Notice of Commencement is required.
14
SUPPLEMENTAL CC?NSTRUCI"fON L1ENTAW IIUFORMATION t
p, ,._. o, � ,�
DESIGNER/ENGINEER: Not Applicable
Name: Livingston Clark
Address: 1702 BEHRENS RD, Fort Pierce FL
City: Fort Pierce State: FL
Zip: Phone
FEE SIMPLE TITLE HOLDER: 0 Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY:
Name:
Address: 1702 Behrens Rd
City:
Zip: Phone:_
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
a Not Applicable
State:
allot Applicable
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 your Notice of Commencement„
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Signature of Owner/ Lessee/Ct ntractor as Agent for Owner
Signature of Contractor/Lice se 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 4th . day of June 2018 by
this 4th day of March 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 o Nota R ;State to )HARRIS
(Signature of No ary Pu4 a W>s�i
' ';.
:• MY COMMIrs��`SPIIaOa��N # FFPQ7093
:�° SOPHIA HARRIS
;.. •=
Commission No. EXPIRE51Crtd� 30, 2020
= '
Commission No. :• MY COMMI �I� # FFt• •?o93
' •.ep„ •
(407)39H.01d3 FloddallotaryServtce.com
''•..,� ,�' EXPIRES Ma
dor 3 Y 30, 2()20
98-0153
FloridallotaryService.com
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Rev. 8/2/17