HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 10/7/2015 Permit Number: 15710- o i l
RECEIVE®
Building Permit Application OCT 0-•7 2015
Planning and Development Services PERMITTING
Building and Code Regulation Division St. Lucie County, FL
2300 Virginia Avenue,Fort Pierce FL 34982 ---
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential X
PERMIT APPLICATION FOR: Roof
'PROPOSED.IMP
ROVEMENT LOCATION:
Address: 4039 N US HWY 1, Fort Pierce FL Lot 11
Legal Description: 203440 FROM INT OF N LI OF SE 114 OF NE 1/4 WITH RM OF US IRUN SELY ALG SO RM/593.68 FTTOPOB,TH WITH ABA OF 76 DEG 45 MIN RUN SWLY TO APT ON
LI OF SE 114 OF NE 1/4,TH RUNS TO SW COR OF SE 1/4 OF NE 1/4,TH E TO SE COR OF SE 1/4 OF NE 1/4,TH NONE U OF SE 1/4 OF NE 114 TO WRAN OF US 1,TH RUN NWLY ON HWY 164.5 FT MIL TO POB(20.03 AC)(OR 3649-1987)
Property Tax ID#: 1420-141-0009-000-0 Lot No. 11
Site Plan Name: Block No.
Project Name: Country Cove MHP
Setbacks Front Back: Right Side: Left Side:
DETAILED DES dyRIFTION OF
WORK: ,"'""'
Roof Repair 4 Squares
CONSTRUCTION PNFORMATIO.N
Additional work to be pertormed under this permit—check all that appy:
HVAC Gas Tank Gas Piping _1:1 ' Windows
— ❑ g Shutters p ❑ Doors/
❑Electric ❑ Plumbing Sprinklers ❑Generator Z Roof
TotalSq. Ft of Construction: 960 S Ft. of First Floor: 960
Cost of Construction:$ 300 Utilities: —Sewer E]Septic Building Height: 9
OWNER/LESSEE:, ;'CO:NTRACTC+R: _
Name Country Cove MHP LLC Name: Roderick Waller
Address:49 SW Flagler Ave#201 Company: Sunrise City CHDO, Inc.
City: Stuart State:FL Address: 800 Virginia Ave Suite 61
Zip Code: 34994 Fax: City: Fort Pierce State:FL
Phone No. Zip Code: 34.982 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.
v
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
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 thepermit 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
commencing work or recordingyour Notice of Commencement.
s
_Signature of Owner/ essee/Agent Signa re of Contractor/ is nse Holder
STATE OF FLORIDA STATE OF FLORIDA 11
COUNTY OF '. ._y COUNTY OF_� .1V1 �.o
The forgoing instr ent was acknowledged before me The forgoing ins ment was acknowledged before me
this 4 day of 20 L�__by this2 day of U01 20 1,�_by
lit
(Name of person acknowledging) (Name of person acknowledging)
Signature of Notary Public-Aate of Florida Whafure of Notary Public-State aFlorida)
Personally Know OR Produced Identification Personally Known` OR Produced Identification
Type of Identification Produced Type of Identification P
Commission No. ,.1111j/•o•; Nota Inc-State of Florida
'"-•- �o�PaYn�e�s LASHAHNA INGRAM
LA INGRAM Commission No. ISI
Notary Public-State of Florida N s• My Comm.Expires Dec 20,2018
• M Comm.Expires Dec 20,2018 =j� ao;= Commission#FF 177249
z"r• oe,� Commission# National Notary Assn.
Revised 07/15/ 1 � oFF`oo-t� Bonded through National Notary Assn.
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