HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: SCANNED Permit Number:
, BY
St. Lucie County REcrnu�
Building Permit Application MAY ViWS
Planning and Development Services
Building and Code Regulation Division Permittlr<g pepattrrient
2300 Virginia Avenue, Fort Pierce FL 34982 St. Lucle County
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential X
PERMIT APPLICATION FOR: Alteration
Address: 6439 PETERSON RD, Fort Pierce FL
Legal Description: 13 35 39 THAT PART OF NW 114 OF NW 114 OF NE 1/4 LYG NELY OF E RIW I-95 MPDAF: FROM NE COR OF NW 114 RUN S 02 DEG 03 MIN 03SEC E
Property Tax ID #: 2313-122-0004-000-0
Site Plan Name:
Project Name: Renovation
Setbacks Front Back: _
I DETAILED DESCRIPTIOMOF WORK: .
Right Side: Left Side:
Enclose front porch and add laundry room to rear of house
N
�A
Lot No.
Block No.
Addniona l worKto normea unaertmspermlt—ClIecrcdu dppry.
off
e
OHVAC Gas Tank ❑Gas Piping _ Shutters Q Windows/Doors
11Electric ElPlumbing []Sprinklers 0 Generator Roof Roof pitch
Total Sq. Ft of Construction: 745 Sp1 —F—t.1 of First Floor: 1949
Cost of Construction: $ 4200 Utilities.. Sewer Septic Building Height: 8
OWNER/LESSEE;
CONTRACTOR:
Name Vanessa Carrington
Name: Roderick Waller
Address:1213 Glynn R Archer Jr DR Lot L
Company: Sunrise City CHDO Inc.
City: Key West State: FL
Zip Code: 33040 Fax:
Phone No.
Address: 103 S Indian River Drive, suite 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: rodwallerl@gmail.com
State or County License: CGC1515114
If value of construction is $2500 or more, a RECORDED Notice of Commencement is requirea.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Q Not Applicable
MORTGAGE COMPANY: ✓a Not Applicable
Name: Wayne Gandy
Name:
Address:
Address:
City: Odando State: FL
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: [Z] 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
commencingwork or rrec-lornding our Notice of Commence ent.
Signature of Ow er/ Lessee/Contractor as Agent for Owner
�t
� r
Signature of Contra tor/License Holder
STATE OF FLORIDA
COUNTY OF St Lucie county
STATE OF FLORIDA
COUNTY OF St Lucie County
The forgoing instrument was acknowledged before me
this 22nd day of May 2019 by
The forgoing instrument was acknowledged before me
this 22nd day of May 2019 by
Roderick Waller
Roderick Waller
Name of person making statement
Personally Known X OR Produced Identification
Type of Identification
Produced
Name of person making statement
Personally Known X OR Produced Identification
Type of Identification
Produced
(Signature of Notary Public- State of Florida)
Commission No. '('Po°110d
_LA SaD is Hatria
l MY Carxnaaioa GG 238373
4M1 y' Erpm Oy,{0/la20
Signature of Nota i
wn Nf&ry Pudic a FWrlaa
C mission No, r �DhlaHarr�ea�
Comm Won GG 236073
4w F�im 05rJ0l1D20
REVIEWS
FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR
REVIEW
PLANS VEGETATION SEA TURTLE MANGROVE
REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17