HomeMy WebLinkAboutBuilding permit appAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �/ �/
Permit Number:
4!�'
�Jj Iace-,
Building Permit Application
Planning and Development Services '
Building ond Code Regulotion Division Commercial Residential
2300 Virginio Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: 'Or'tr011-7 o4
PROPOSEDIMPROVEMENTLOCATION:
Address: 0 /; S CPtiirJ i 5-
Property Tax ID #:
Site Plan Name:U
Project Name: J `
F//-50/—O,
Rd
DETAILED DESCRIPTION OF WORK:
0-000-6'
Lot No.
Block No. Li
o /�')'d A le o k'1J /7 07, y 5y _J�rr, o , P ha in
19/1 0,^-,;54 I-02M
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
Electric _ Plumbing J _ Sprinklers
Total Sq. Ft of Construction: 7 � t�
Generator
Sq. Ft. of First Floor:
Windows/Doors Pond
_ Roof Pitch
Cost of Construction: $ /900-po Utilities: Sewer _ Septic Building Height: �Y`7_
OWNER/LESSEE:
CONTRACTOR:
Name JQ of en r 4n Q
it
Name: A161171
J,
ti
Address: 220/ S-Z-. Le Ai CT
Company: 4 >
mT�`! % o w (/C. r%!
City: 1 7' State: /CL•
Zip Code: Fax:
Phone No. J G� " 8�i�- %8J /
Addres--s);�eiJ
.
6Cr
City: z?.e4C'4
Zip Code: YtIF
Phone No 7 72 -
7
2 60 -5-
State: /1-17/•
Fax: 7Z223_2,1 c%1
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail efC14-r M n ;
C q p0• e-am
State or County License ���
/� SO !�✓
VQ — U wiiNuuLuUn IN c:)uu or more, a rctLUKUtu Notice of commencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
I SUPPLEMENTAL -CONSTRUCTION LIEN LAW INFORMATION: / I
DESIGNER/ENGINEER:
Name:
Address:
City:
Zip: Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City: _
Zip: one:_
Not Applicable
State:
_ No plicable
MORTGAGE COMP A _ Not Applicable
Name:
Address
A-` State:
p: Phone:
BONDI OMPANY:
Name:
Address:
City:
Zip: Phone:
_Not Applicable
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 commencine work or recordine vour Notice of Commencement.
Signature of Mwner/ Lessei�7`C&hTractor as Agent for Owner I Signature of Contractor/License Holder
STATE OF FLORlDA STATE OF FLOR
COUNTY OF �'ia0 �� �1 COUNTY OF 1 M a r-%'L:)
Swofn to (or affirmed) and subscribed before me of Swofn to (or affirmed) and subscribed before me of
V Physical Presence or Online Notarization Physical Presence or Online Notarization
this I I-W\day o`fk1()✓erhb{-r 2020 by this ) 1+�dJay of N1()v�P_ , 2020 by
Ah c-m ?flM i �'1 , A //lc�M _-- lI --
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification c' < S
Type of Ide tification 4L
Produced K6 r L d , D �
I 1a.,t,L Y%la b�
(Signature o'fS[/you�/tta/,ryy� Public- State, {y4prida) ��w
. S.%V�-W �C07 2O: "'.Blic WRY L.Eg MAT
Commission o. ION #GG06464
IRES: March 6, 2021
FOF Fl"� L30rlt TUU B doaf M.r_
Personally Known OR Produced Identification Q
Type of Identification
Produced IIM� 0 itG1 A L_
0 1Ga,La.F� t .0 l )' la-Z/
Y
(Signat a of Notary Public- State of � MWLEE MATM
*a
MY COMMISSION # GG 0
Commission No. 4 `"? ppa1))��E� pIREpS:�M,,�h6 4;
y"eOF FIOF\ "'+ *4 �U """`J��"� Notary S
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
L-IZJMIJ
Adam Smith Service Inc.
661 NE Spencer St.
Jensen Beach, FL 34957
adamsmithinc@yahoo.com
ph. 772-232-2566 fax 772-232-2191
Steve Orlando
Contract
Invoice Number: 10720
Issue Date: 10/26/2020
Due Date: 1112512020
Qty
Item
Description
Unit Price
Total
1
tdlh
Tear down, load, and haul mobile home and FL room from
$1,900.00
$1,900.00
lot 252 Holiday Out including all permit and landfill fees
1
sb
Sign bottom and return for acceptance of proposal
$0.00
$0.00
Subtotal
$1,900.00
Total Amt
$1,900.00
Balance Due
$1,900.00
Thank you for your business.