HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAPPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED r NP-1
te: 10/22/18 Permit Number: l o-
SCANNED
Building Permit Application StLucPY RECI�IIED
►e Co�(f,�1
ing and Development Services �l lir(LIi 2018
ng and Code Regulation Division
Virginia Avenue, Fort Pierce FL 34982 Permitting Department
e: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential fit• Lucie county
PERMIT APPLICATION FOR: Roof
Address: 2;A _� Q s ! LV gy N VA r 6rT
Legal Description: SAN LUCIE PLAZA S/D-UNIT ONE- BLK 48 E 12.5 FT OF LOT 2 AND ALL LOT 3 AND W 31 FT OF LOT 4 (MAP 14/33N) (OR 4108-2831)
Property Tax ID #: 1428-702-1008-000-5
Site Plan Name:
Project Name:
Setbacks Front Back:
Right Side: Left Side:
old shingles and install new 5v metal
UHVAC U Gas Tank
❑ Electric 0 Plumbing
Total Sq. Ft of Construction: 1664
Cost of Construction: $
5230.00
Lot No.
Block No.
Gas Piping _Shutters Windows/Doors
Sprinklers F� Generator Roof Roof pitch
S Ft. of First Floor: 1664
UtilitiesSewer 0Septic Building Height:
01NNERLESSEE
E,
CQNTRACTOR
z. ....n
..,,� ... _
�..
Name Dolores R Hoffman
Name: Roderick Waller
Address: 6180 SE Mariner Sands DR
Company: Sunrise City CHDO Inc.
City: State: FL.
Address: 130 S Indian River Drive
Zilp Code: 34997 Fax:
City: Fort Pierce State. FL
Phone No.
Zip Code: 34950 Fax: 772-907-0420
Phone No. 772-201-2850
EfIMail:
E-Mail: rodwaller1@gmail.com
Fi1I in fee simple Title Holder on next page (if different
fri m the Owner listed above)
State or County License: CCC1327208
It value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL
CONSTRUCTION LIEN LAW INFORMATION
N
'_''�4f',.
Y ... � ... P.�r ✓. w .°
DESIGNER/ENGINEER: Q
Not Applicable
MORTGAGE COMPANY: Q Not Applicable
N am e: Dolores R Hoffman
Name:
Address: 6180 SE Mariner Sands DR
Address:
City: 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 vour Notice of Commencement.
Signature of Own r/ Lessee/Contractor as Agent for Owner Signature of Contrac or/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF St Lucie County COUNTY OF St Lucie County
I
The forgoing instrument was acknowledged before me
this 22nd day of _October 20 18 by
Roderick Waller
Name of person making statement
Personally Known x OR Produced Identification
Tvne of Identification
of Notary Public- State of Florida )
mmission No.
IEWS
ECEIVED
ATE
OMPLETED
8/2/17
L(6�1IiVA INGRAM
Notary Public - State of Florida
My Comm. Expires Dec 20, 2018
G -•'`•- aunuea [nrouan W110 al n a V
FRb--Z—&NlR}C ;:~SU ? ,ISM
COUNTER REVIEW REVIEW
The forgoing instrument was acknowledged before me
this 22nd day of March 20 18 by
Roderick Waller
Name of person making statement
Personally Known X OR Produced Identification
Type of Identification
Produced
urd of Notary Public--Statgf Florida )
Commission No. (SdAl)AHNA INGRAM
_�* . `;`•; Notary Public - State of Florio
• ; ; • My Comm. Expires Dec 20, 20
PLANS I REVIEW VREV REVIEW 1 REVIEW REV ESO W