HomeMy WebLinkAboutApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: /D - zP'-zo
Permit Number:
0
--�,_ 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:
PROPOSED IMPROVEMENT LOCATION:
Address:
Property Tax ID #: 3 y 0 2- 0 6- Oji,? - 6 6 0- 3 Lot No. 3I;2
Site Plan Name: �7 Block No.
Project Name: C„ -0
DETAILED DESCRIPTION OF WORK:
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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 _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ of 0 3 r, Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
Name: /jl« XOC% �4yld
Address: '� /< er, f/ec Tra
Company: 4C-1 44 rP-1c--4 R L�
Address: /F/.F K -L VLI ,a
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City: /- f /'-Ce--CC State:
Zip Code: (/� 2 Fax:
City: f5' 'L %f (/ C- State: 15�1
Phone No. 7 -7 J-7 /`' _ 7.2 7 I
Zip Code: 7 M�p Fax:
E -Mail: i7i��>L� Fr/ 4� 'I�/vin/'yor�r-csC��
Phone No 77,2 - TTV- -137F
Fill in fee simple Title Holder on next page ( if different
E -Mail AC_ ��'�,� )CP -1 r 17 L Z' c> A6e-1, L6/7
from the Owner listed above)
State or County License 1(
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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: 15hone
Zip: one:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: _Not Applicable
Name:
Name: _
Address:
Address:
-r
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 attorney before commencing work or recording your Notice of Commencement.
-- i
Signature of Owner/ Lessee/Contractor as Agent for Owner Signature of Contractor/license Holder
STATE OF FL
COUNTY OF
Sw3yrn to (or affirmed) a
Physical Pre ce
this day of -
"I
Name of person making statement.
d bef8WY4 bfJEwELL
ir4t AVN of Flei i4a
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M0ixpires Dec 5, 202 3
Personally Known OR Produced Identification
Type of Identification
Produced
STATE OF FLORI
'
COUNTY OF I )
Sworn to (or affirmed) and su s� i
Physical Pre en r "
atJEWELL
ihisc� day of °
}}�� �I c cafe of Florid,r
` 1winsion r GG 937394
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VVI \ C� � � . - G ^"
My Comm. Expires Dec S, 2021
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
Produced
(Signature of Notary Public- State of Florida) I (Signature of Notary Public- State of Florida )
Commission No. (Seal)
Commission No.
(Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
1915 RIO VISTA DRIVE
FORT PIERCE, FL 34949
actionfencinginc@gmail.com
772.834.3379
ACTION FENCING, INC
CUSTOMER:
S
BILLING ADDRESS:_ Al"d JMIJ
PHONE:
PROJECT PROPOSAL
Action Fencing Inc Representative: X'6�—
Proposal Date: 14', Z �7 - Z''
Proposal Valid Through: /i - q- 7, c?
INSTALLATION LOCATION:
PERMIT NUMBER:
Action Fencing Inc hereby proposes to furnish the materials and perform the labor necessary for the completion of:
WORK PROJECT DESIGN & DRAWINGS
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[Ali material Is guaranteed to be as specified, and the work to be performed In accordance with the drawings and speclflcaUons submitted for above work and
ompleted In a substantial workman like manner for the sum of: '
�/) % upon bid acceptance, % upon materials delivery, and remainder due upon job completion.
Payments to be made as: l
PROPOSAL ACCEPTANCE: The above specifications, conditions, price and payment schedule are satisfactory and hereby accepted.
SIGNATURE
DATE
SIGNATURE