HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Dat I Permit Number: �1
• BY RECEIVED
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Building Permit Application St, LuciieDimmA412, zone
Plant``� ng and Development Services Department
Buildrng and Code Regulation Division ling
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential X
11
PER MI,IIT APPLICATION FOR: Roof
PROPOSED'IIVIPROVEMENT LO.CATI,ON-
Address: 360 SW AIROSO BLVD, PORT ST LUCIE FL
Legal Ipescription: RIVER PARK -UNIT 6- BLK 56 LOT 10(MAP 34/28S) (OR 1152-2986 THRU 2988: 1161-2043 AND 2044)
Propel' y Tax ID #: 3419-545-0011-000-9 Lot No.
Site P�I n Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED",DESCRIPTION OI= WORK "
Remolve and replace torchdown FL1654-r22
Haaifionai work to oe errormea unaer tnis permit— cnecK all apply:
DHVAC Ei Gas Tank []Gas Piping _ Shutters Q Windows/Doors
El Electric 0 Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: 2,985 S . Ft. of First Floor: 2,985
Cost if Construction: $ d,,26b• 62� Utilities. Sewer E]Septic Building Height:
01N�lER/LESSEE
CONTRACTOR nP.
Name Nancy Mae Leonard
Name: Roderick Waller
Address: PO Box 525
Company: Sunrise City CHDO Inc.
City:10ensen Beach State: FL
Address: 130 S Indian River Drive
Zip Code: 34958 Fax:
City: Fort Pierce State. FL
Phonle No.
Zip Code: 34950 Fax: 772-907-0420
E-M ail:
Phone No. 772-201-2850
Fill in fee simple Title Holder on next page ( if different
E-Mail: rodwaller1@gmail.com
State or County License: CGC1515114
from the Owner listed above)
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
StJ3P!PEE
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ME�NTAL`CONSTRUC I,ON LIEN
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LAW INFa(3RMATI(3N
DESIiGNER/ENGINEER:
N a m
Address:
Not Applicable
e : Nancy Mae Leonard
MORTGAGE COMPANY: EL Not Applicable
Name:
360 SW AIROSO BLVD, PORT ST LUCIE FL
Address: PO Box 525
Jensen Beach State:
City: State:
city:
Zip:
I
Phone
I
Zip: Phone:
FEE
Name:
Addt�ess:
IMPLE TITLE HOLDER: 0 Not Applicable
BONDING COMPANY: ✓ LNot Applicable
Name:
Address:
City:
City:
Phone:
Zip: Phone:
Zip:
I
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certi I that no work or installation has commenced prior to the issuance of a permit.
St. Luc County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which s in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structLli•e. 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 acc i�dance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The folPwing building permit applications are exempt from undergoing a full concurrency review: room additions,
accesspry structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
WARNING
ING 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.
C
Signzi u"re of Owner) Lessee`, Contractor as Agent for Owner Signature'of Contractor/License older
STA, E OF FLORIDA STATE OF FLORIDA
COUNTY OF St Lucie County COUNTY OF St Lucie County
The f`l`Qrgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 27th day of August 2018 by this 27th day of August 20 18 by
Waller Roderick Waller
Name of person making statement Name of person making statement
Ily Known X OR Produced Identification Personally Known X OR Produced Identification
Identification Type of Identification
Produ d.
re of tary Public- Stag f r' (Signature of khotary Public- State of Florida )
Corn
ission Notary '
Commission No. dr pub11o3 e�
• ply Gomn►wion GG 238873
oxide
Sophia Harris
Expires p5I3012020
d` MY Commission GG 238873
as
d� Ex irea 05
RE
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FRONT
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SUPERVISOR
PLA
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SEA TURTLE-
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REVIEW
REVIEW
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REVIEW
REVIEW
REVIEW
DATP
RECEIVED
DATE
COMPLETED
Rev. 8%2/17