HomeMy WebLinkAbout0025 Bergeron Drywall PermitAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
01ro [LUCE�
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K C" LL ° a, Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential X
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: Lisa Marie Bergeron
PRQPOMED 1MPROYEMENT LOGCgJON:
Address: 607 Brack RD Fort Pierce, FL 34982
Property Tax ID #: 3403-701-0049-000-3
Site Plan Name: HUNT'S SID BILK B E 25 FT OF LOT 21 AND ALL LOTS 22 AND 23 (0.37 AC)
Project Name: 0025 Bergeron
DETAILED DESCRIPTION OF WORK.,
Repair I Replace 100 Sq Ft of Drywall
New Electrical Meter Second Electrical Meter.
(;ONSTRIJCTLON [XOMATIO)V
Additional work to be performed under this permit -- check all that apply:
Lot No. 21,22 & 23
Block No. B
_Mechanical —Gas Tank —Gas Piping _Shutters Windows/Doors Pond
Electric —Plumbing — Sprinklers _ Generator Roof Pitch
Total Sq. Ft of Construction: _
Cost of Construction: $ 3200.00
OWNERAESSEE:
Sq. Ft. of First Floor: 1110
Utilities: —Sewer —Septic Building Height:
Name Lisa Marie Bergeron
Address: 607 Brack RD
City: Fort Pierce State: FL
Zip Code: 34982 Fax:
Phone No. (772) 672-1393
E-Mail: lbergeron391 I @gmail.com
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
CONTRACTOR:
!Name: James W Foster
Company: Patriot Response Group
Address:2770 Indian River Blvd Suite 501
City: Vero Beach State: FL
Zip Code: 32960 Fax:
Phone No 850-603-9451
E-Mail permitting@patriotrg.com
State or County License CGC-1526178 -
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
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
_
Address:
City: State:
Zip: Phone:
City: - State:
Zip: Phone
FEE SIMPLE TITLEHOLDER: _ Not Applicable
Name:
Address:
BONDING COMPANY: _Not Applicable
Name:
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 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
�ui+k Icnrinr nr nn o+fnmaw hnfnrn rnmmc,nrinc wnrk nr rarnrrling vnllr NntirP of Commencement.
Signature of Owner/ LessegIContractor as Agent for owner
Signature Contract r/License Holder
STATE OF FLO IDA
STATE OF FLORIDA
COUNTY OF �j&4 2014.0.._
COUNTY OF Okaloosa_ _.
Sworn to (or affirmed) andsubscribed before me of
Sworn to (or affirmed) and subscribed before me of
2�Rysical Pr ence or Online Notarization.
Physical Presence or Online Notarization
day ofli 2020 by
j this ��layof_necember ,2020 by
�"IS
James Foster
Name of person makinif statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known _X_ OR Produced Identification
Type of Identification
Type of Identification
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(Signature of Notary Public- Stat eaue,1 a
Vance H Olvey
Commission No. + My Com�HH 037633
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