HomeMy WebLinkAbout2020-06-26_122634Fh
F L. 0 R 1 D A
the
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
(Company me/Individual Name)
(Type of Trade)
BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT
have agreed to be
Sub -contractor for(- i si
C,
(Primary Contractor)
For the project located at%�0 0 � � \A S f (y `
(Project Street Address or Property Tax ID #)
Tt is understood that, if there is any change of status regarding our participation with the above mentioned
project, the Building and Code Regulation Division of St. Lucie County will be advised pursuant to the
filing of a Change of Sub -contractor notice.
r
CONTRACTOR SIGNATURE (Qua' er)
T�
PRINT NAME
LAC 06 S1 _), 1�
COUNTY CERTIFICATION NUMBER
State of Florida, County of ina-CL t1
The foregoing instrument was signed before me thig2 �A day of
26k)by
who is personally i nowqj` or has produced a
of Notary Public
ry 9001i0 State of Florida
Nota
g Pat MCPeak GG 276671
., Commission
�. ExP;res 03108120
23
Revised I III
STAMP
SUB -CONTRACTOR SIGNATURE (Qualifier)
PRINT NAME
COUNTY CERTIFICATION NUMBER
State of Florida, County of �� Y'1
The foregoing instrument was signed before mejt�his Q,day of JW
(.j 2 by L.i�(.[,4 i J
who is personally know.( a as produced a
Print Name of Notary Public
�ayotPublic State a1 Florida
f9aN at Wpeaky cornmissiOn GG 275671
J� Expire' 031QBI2023
STAMP
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5 �0we
aA r}� �r� f1,15J4 �
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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: _61-91101Q._ Permit Number:
�5oo LUCE ~
Building Permit Application
Planning and Development services j
Building and Code Regulation Division Commercial 2/ Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 452-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address:
Property Tax ID #: Lot No.
Site Plan Name: W 'AfPu
Block No.
Project Name: Ns, s%ofi�a" a�iea.
DETAILED DESCRIPTION OF WORK:
!�'. Y)GFtr [l�� YS T7lf�('!' �ie c-�r� 1 ✓i..r, r/ /
v -rT r i ' h�� w I -
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit- check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ _ Windows/Doors Pond
Electric -�1-41umbing _ Sprinklers Generator Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Sca.
I
Name: V
Address:
_
Company:(_c't LL C—
City: 4JO State.
Zip Code: Fax:
Phone No. 31�f— (19--�9�.�
Address: S,- CL'JiYta, V
City: - I~WavI _ Stater
Zip Code: 21/Fax:
Phone No 2 -;VO - �L
E-Mail.
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E--Mai 15 67kJL- iris -%cis 1 ��yE,a, •Ct�
State or County License
.- ...,... w, --iF lul1 a a uu u1 1wou—, a nrw unuru Novice of Commencement is requ[rea.
If value of I4AVC is $7,500 or more, a RECORDED Notice of Commencement is required.
SiUPPLE:MENTAL CONSTRUCTION LIEN, LAWINFORMATION:
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:
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.
Lucie County and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
with lender or an attornev before commencing work or recording vour Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Hol r
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF 1Y'
Sworn to (or affirmed) and subscribed before me of
SVvprn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
-Physical Presen or Online Notarization
this day of 12020 by
thls day of 2020 by
ear(
Name of person making statement.
Name of person makings ement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature of Notary Public- State of Florida)
(Signature of Notary Pu
, ,..•'4vj ,: TMATHILLBERG
Commission No. (Seal)
Commission No. ;*: MYCO(hlMA8§0N#GG983417
eQ= EXPIRES: April30.2024
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Kev. 5/b/LU