HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONf5
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ALL APPLICABLE INFO )MI/UST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date•_Iuu'�'- ! 1 1 �•� Permit Nu "►/—�'--(-
111
Building Permit ApplicatioLesial
OV 4 2m
Planning and Development Services ing. Department
Building and Code Regulation Division
2300Virginia Avenue,Fort Pierce FL34982 cie County, FL
Phone: (772) 41 2-1553 Fax: (772) 462-1578 Commercial
PERMIT APPLICATION FOR: Roof SCANNED
PIKUPUSIH) I , 'F Uq M E,NT, LUCATIO'N Loirtp r''ni
Address: 2314 St Lucie Blvd, Fort Pierce FL
Legal Description: SAN LUCIE PLAZA S/D-UNIT ONE- BLK 53 LOTS 2, 3, 4 AND 5 (MAP 14/28S) (OR 1987-816)
Property Tax ID is 1428-702-1125-000-1 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
Remove &
Flat Section only in rear of house( 13Sq Modified Bitumen) FL1654-R22
Aaaitional work to t,e ertormed under this permit —check all apply:
�HVAC i Gas Tank ❑Gas Piping _ Shutters ❑ Windows/Doors
Electric ❑ Plumbing Sprinklers F Generator ❑✓— Roof ICE Roof pitch
Total Sq. Ft of Construction: 130 S . Ft. of First Floor: 2777
Cost of Construction: $ 2230.00 Utilities: Elewer E] Septic Building Height:
01NNER/LES,SEE
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CONTRACTOR s
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Name Dorothy Smith
Name: Roderick Waller
Address: 2314 St (Lucie
Blvd
Company: Sunrise City CHDO Inc.
Address: 130 S Indian River Drive
City: Fort Pierce I State: FL
Zip Code: 34996, Fax:
City: Fort Pierce State: FL
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: rodwallerl@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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW
o
INFORMATION
�.
DESIGNER/ENGINEER: Q Not Applicable
MORTGAGE COMPANY:
Q Not Applicable
Name: Dorothy Smit h
Name:
Address: 2314 St, Lucie Blvd, Fort Pierce FL
Address: 2314 St Lucie Blvd
City: FortPierce I State:
City:
State:
Zip: I Phone
I
Zip: Phone:
FEE SIMPLE TSTLE HOLDER: 2:1 Not Applicable
BONDING COMPANY:
allot Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: I Phone:
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 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 witl1 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 linspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording vour Notice of Commencement.
I � "L") AU
Signature of Ow r/ Lessee/Contractor as Agent for Owner Signature of Cont ctor/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 14th day of November 20 18 by this 14th day of November 20 18 by
Roderick Waller I
Name of person making statement
Personally Known X OR Produced Identification
Type of Identification
(Signature -of Notiary Public- State of Florida
CommissJDnJ#6.0_(*_ NotaryPubkSUftofFl 1)
�s My Commissidn GG 238873
•00 Expires 05/3012020
Roderick Waller
Name of person making statement
Personally Known X OR Produced Identification
Type of Identification
Produced
_9_2,�,L_ �"\
(Signature of Notary Public- State of Florida )
Commission N Steil orida
Sophia Harris
y'9p, Al My c:ommisaion GG 238873
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Rev. 8/2/17