HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1/23/2019 Permit Number:
RECEIVE®
Building Permit Applicat
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial
JAN 2 3 2019
:tin Department
d6k-CGi fPty, FL
PERMIT APPLICATION FOR: Roof 0^..- 111
Address: 2317 St Lucie Blvd, Fort Pierce, FL " `'u(;te COUrrt,
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 LOT4 (MAP 14/33N) (OR 4108-2831)
Property Tax ID #: 1428-702-1008-000-5
Site Plan Name:
Project Name: Re -Roof
Setbacks Front Back:
::DETAILED DESCRIPTION OF WORK:
Right Side: Left Side:
Re -Roof - Tear off and Replace Flat Roof Section
CONSTRUCTION-6NFORMATION'_' �-•. -,r
Mona wor to eoe orme under tispermit—check all apply:
L_IHVAC LJGas Tank
Electric 0 Plumbing
Total Sq. Ft of Construction: 200
Cost of Construction: $ 2400.00
Lot No.
Block No.
as Piping _Shutters ❑Windows/Doors
3rinklers ❑ Generator ❑✓ Roof ® Roof pitch
S Ft. of First Floor: 1746ff—
�
Utilities: []Sewer0Septic Building Height:
OWNER/LESSEE!': "
CONTRACTOR:
Name Dolores R Hoffman
Name: RODERICK J WALLLER
Address: 6180 SE Mariner Sands DR
Company: SUNRISE CITY C. H.D.O. INC.
City: Stuart State: FL
Zip Code: 34997 Fax:
Phone No.
Address: 130 S INDIAN RIVER DR. #202
City: FORT PIERCE State: FL
Zip Code: 34950 Fax: 772-907-0420
Phone No. 772-201-2850
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail: RODWALLERI @GMAIL.COM
State or County License: CCC1327208
It value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCT.ION LIEN LAW INF6RMATLON.
'
DESIGNER/ENGINEER: _
Name:
Not Applicable
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
Address:
City:
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER: _
Name:
Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
Address: 130 S INDIAN RIVER DR. #202
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 co 1 ict 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.
F'lJ�
Signature of Owner/ Lesse f/Contractor as Agent for Owner
Signaturb of Contractor License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF ST. LUCIE
COUNTY OF ST. LUCIE
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this 23nd day of January . 2019 by
this 23nd day of January , 20 19 by
RODERICK J WALLER
RODERICK J 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
Pr ed
Produced
(Signatur of Notary Public- State of Florida)
(Signature of Motary Public- Stateiooff Florida J
Commission No. 05/30/2020 (Seal)
Commission No. 05130/2020 (Seal)
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Rev.8/2/17