HomeMy WebLinkAboutChange of Contractor All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED (�
Date: Permit Number: 'I'cuQ 0 10.
T.
IA
405 0- Building pp 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=IM�PROVE;�MENT LOCATION __ _ _
Address- q2zol Wok
Property.Tax ID#: Cmr-&P- l 33Z bL-C404- Q of-1 Lot No.
Site Plan Name: p e S e l nerA r h Block No.
Project Name: ('f�y;_I' rat. L' {'louse PanoUK-ftt�stt�04�
,D_E�TrAI y D-D�ESCRIP-�T�LONzOF'WOR�K ^'
o0 0h OF f-69- -e a; i�cln
ti � Ieinj to&(1- R fon4all new o- &90
New Electrical Meter /Second Electrical Meter
k
Additional work to be performed under this permit-check all that apply:
r _Mechanical _Gas Tank —Gas Piping _Shutters —Window oors _Pond
_Electric V Plumbing _Sprinklers _Generator Roof Pitch
Total Sq. Ft of Construction: // Sq. Ft. of First Floor:
Cost of Construction:$����aj_(7 Utilities: _Sewer _Septic Building Height:
OWNER/L'ESSEE 'CONTRACTOR77
Name Name: C,
Address: 1-m>[ Woo(& Cop W&,Q Company:
City: L State:�� Address:
Zip Code: Fax:-V1 ZY�) City: State:
Phone No. r Z >Zq � 3 o Zip Code: Fax:
E-Mail: VYWQIQL Lq Phone No
Fill in fee simple Title Holder on ne t page(if ifferen 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 Js$7,50.0 or more,a RECORDED Notice of Commencement is required.
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�tJ PLENIENTAt:CO STRUCTION�LIEN I:AW�lNF�RMA�lON �___ _ _� � f ''.
DESIGNER/ENGINEER: of Applicable MORTGAGE COMPANY. tAppt!cable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLEHOLDER:' Not'Applicable BONDING COMPANY: _NotAppIicable
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 permitholder to build the subject structure
which is in conflict with any applicable Home Owners.Association rules,bylaws or and covenants thatmay restrict or prohibitsuch
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 exemptfrom undergoinga 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 our Notice.of Comaigncement.
Signature of Owner/Lessee/Contractor as Agent for Owner Signa re of Contra r/uce of r
STATE OF FLORIDA STATE OFF orzt'40
COUNTY OF_ COUNTY OF
Sword(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of
t/Phvsfcaf Presence or nllne Notarization P ysical Presence or Online Notarization
this 2 y of ai�P.�Y�- V .2020 by thi day of '���21�OZ0 by
6cu)fA c,-riAie-
V1 rn
Name of person makin7sta meet Name of person making stat nt.
Personally Known R Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification•,
Produced Produced ��---
(Signature of UotarV Public-State i r of Notary
Nohuy Pub6a state fi- rii
Commission No.��• l e )MY 13Q 9 �nissl TARY PUBLIC-STATE OF C f ADO
�M Expiroa GIR7!lD23 04023 B
MY COMMISSION E
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATUR ROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE -
COMPLETED
ev.