HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO) MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 7• / Permit Number:
Building Permit Apl;Ciq1f p9 FED 7 2018
Planning and Development5ervices 13Y
Building and Code Regulation Division St. Lucie Countv
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial X Residential
Address: 3100 ST LUCIE BLVD, Fort Pierce FL
Legal Description: SAN LUCIE PLAZA S/D-UNIT ONE- BLK 62 LOTS 1, 2, 3
Property Tax ID #: 1428-702-1420-000-9
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side:
Install %Chain Link Fence with(1 �' Gate
Aaauwnd1 worK to oe enormea unuer tors Permit —a
I]HVAC Gas Tank ❑Gas Piping
11 Electric 0 Plumbing 05prinklers
Total Scl.of- of Construction:
Cost of Construction: $ ra�oZ D l7
Gate
Lot No.
Block No.
LeftSide:
Shutters Windows/Doors
Generator 11 Roof = Roof pitch
S Ft, of First Floor: _
Utilities:11 Sewer Septic
Building Height:
OWiUi3%LESSEE K aG, c`_
CQNTRACTOR
Name Northside Christian Fellowship
Name: Roderick Waller
Address:
Company: Sunrise City CHDO Inc.
City: Fort Pierce State: FL
Zip Code:-34946- Fax: -
Phone No. 802-280-5472
Address: 3550 Okeechobee Rd
City: Fort Pierce State: FL
Zip Code: 34947 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 required.
I'�A:�G>`C;•N � �UCT(Ol��`lE[`� fA1��I1Fr3�t�itl�4i[€�,I`�
��� �NGINEER:
Q Not Applicable
e Christian Fellowship
imm7n
MORTGAGE COMPANYNot
Name:
Applicable
5T U1CIE BLVn, Fort Pierce FL
Address:
State:
Phone
City:
Zip: Phone:
State:
FEE SIMPLE TITLEHOLDER: O Not Applicable
Name:
BONDING COMPANY:
Name:
QNot Applicable
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
commencine work or recordine vour Notice of Commencement
l���-Q L-
UJ � ��� -
Signature of ontractor/Licen a Holder
Signature of Owner Les t-
e/Contractor as Agent for Owner
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 6th day of February 2018 by
this 6th day of February 2018 by
Roderick
Roderick 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
Produced
Produced
(Sig ature of Not ry , : .i,�tate of �� A HARRIS
(Signatu
a Rr; QQary u IL HA I
Commis
�� :� MY COMMISSION # FF(9�g1(13
Commission No. - MY COMSSJ�ptV # FF997093
•.••w ,,' EXPIRES May 30, 2020
'• �•• EXPIR S Mo�llly 30, 2020
Nei) 38H-0153
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Rev. 8/2/17