HomeMy WebLinkAboutChange of Contractor AII,APPLICABLE INFO MUST BE.COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: 10'
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax:(772)462-1578
PERMIT APPLICATION FOR:
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Address: �G/ � G r f' '_ FZ 3 d
Property Tax ID##: J H "tt2 l " d -I c4i-" (00o —� Lot No.
Site Plan Name: Block No.
Project Name:
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New electrical Meter Second Electrical Meter
Additional work to be performed under this permit—check all that apply:
—Mechanical _Gas Tank _Gas Piping Shutters Windows/Doors _Pond
Electric )(Plumbing _Sprinklers Generator Roof Pitch
Total Sq. Ft of Construction: �^ Sq. Ft.of First Floor:
Cost of Construction:$ 'r�,o� Utilities: _Sewer _Septic Building Height:
rx., n
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Name
{'i G� h(�i Name:
Address: •S,01"-04-6 tn. Com an _
City: '" P_ State: tL�7 Addre'ss Y ; .....r
Zip Cade: - q tFaax: City_ State:
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Phone No. 6 c2 0.3— 7t.�1 Zip Cac3'e -"Fax.
E-Mail: d 4lG- r 411:;l&_ J` �jDa�l.-Cvrx( Phone No
Fillin fee simple Title Holder on next page( if different E-Mail
from-the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
If value of HAVC is$7,500 or more,a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: _Not ApplicableMORTGAGE 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:
.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:paying twice for
improvements to your property. A-Notice of Commencement must be recorded.in the public records of St..
Luce County and ted on the jobsite"before the.first inspection. If you intend to obtain financing, consult
WAhVnderof')PKat0rney bpf9rq,,Qommencing work or recording our Notice of Commencement. -
Signature Owner/ ssee/Contractor as Agent for Owner Signature of Contractor/License Holder .
STATE.OF FLORIDA ) / STATE OF FLORIDA
COUNTY OFA` !LlGi C�• COUNTY OF
Sworn to(or affirmed)and subscribed before.me of Sworn to(or affirmed)and subscribed before me of
Physical Pre . ce or Online Notarization Physical Presence or Online Notarization
this i_day of 20,'2�by this day of 20. by
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Name - person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification.
Type of Identification Type of Identification
Produced Fl— L Produced
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(Signature of Notaryblic- tate of Florida . (Signature of Notary Public-State of Florida)
Commission No. '•` �"" AUDREYB. �IREY Commission No. Seal
.: ;. COMMISSION#GG 300817
EXPIRES:March 6 2023
bondedThru Notary Pubiia derMiteis
REVIEWS FRONT' _Z0 19 119 G ISOR PLANS' VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.