HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED i p
Date: 2 �t SCANNED Permit Number: 1363 ^ 032-
BY RECEIVED
ST LUCIE COUNTY
MAR ] 2 71118
Building Permit Application
Permitting DepartmOnr
Planning and Development Services st. Lucie county
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial X Residential
PERMIT APPLICATION FOR: Other
PROPOSED IMP,ROU,EMEa LOCATION M
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 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
TAll'1;6dh0SGR(PTlnfgi- -� 1/t7Rf(
JJF
Install 2 Shipping Containers per plans
Iva Giec;WC_ 1No P IVU3`.7
11HVAC
Gas Tank
11 Electric
Plumbing
Total Sq. Ft of Construction:
Cost of Construction:
$ 1000.00
unsperma— Cnecxau apply:
❑Gas Piping _ Shutters ❑ Windows/Doors
Sprinklers E] Generator D Roof = Roof pitch
S Ft. of First Floor: _
Utilities: Sewer 0 Septic
Building Height:
"QWNERILESSEE' _ .= z fi 4
CONTRACTOR
Name Northside Christian Fellowship
Name: Roderick Waller
Address: _
_Company: Sunrise City CHDO Inc.
City: Fort Piece — - State: F�
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@gmaii.com
State or County License: CGC1515114
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
14*
UPRL-EMENTAL CONSTRUCTION LIEN LA1tV
tNFORMATIQN
DESIGNER/ENGINEER: Q Not Applicable
MORTGAGE COMPANY.
Q Not Applicable
Name: Northslde Christlan Fellowship
Name:
Address: 3100 ST LUCIE BLVD. Fort Pierce FL
Address:
City: Fort Pierce State:
City:
State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: 0 Not Applicable
BONDING COMPANY:
QNot 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 Countyy 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.
as Agent for Owner I Signature of
STATE OF FLORIDA STATE OF FLORID
COUNTY OF St Lucie county COUNTY OF St Lucie
The forgoing instrument was acknowledged before me
this 12th day of March . 20 18 by
Roderick
Name of person making statement
Personally Known X OR Produced Identification
Type of Identification
The forgoing instrument was acknowledged before me
this 12th day of March 20 18 by
Roderick Waller
Name of person making statement
Personally Known X OR Produced Identification
Type of Identification
(Signatur gfi,t;yPubl'�,jF�pflFjlA�pl� (Signature of - ublic-$rpypFjjftloRIS
MY COMMISSION p F 93 '�= MY COMMISSION F9 7093
Commissi Commission a.• ES Ma a
'•. •ar RES May 30. 02C y 3 . 0�0
(�01)3W-015]—Fbritlallom�Sav�xmo_— (16/ 0Ygd153 Fbrp�NotarySerwc�,�,
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
-COUNTER REVIEW -REVIEW REVIEW REVIEW REVIEW REVIEW
RECEIVED
DATE
COMPLETED
Rev.8/2/17