HomeMy WebLinkAboutDEMO APP_SUBSAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 12-'� b��� Permit Number:
ZS", L U c L L
U L 1 ` _ 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: �eo
PROPOSED IMPROVEMENT LOCATION:
Address: 3433 G-,x-4.N ?.d. .
Property Tax ID #:a3a•l,c - 4 1 aolo- _�Do - dL Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
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 ]C Plumbing _ Sprinklers _ Generator Roof Pitch
Total Sq. Ft of Construction: 31 9 al0 Sq. Ft. of First Floor: �k
Cost of Construction: $ (J ) d C'C' Utilities: —Sewer _Y Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name UNA f 60-r
Name:A • G vt:,�
Address: C ':,Cites d.•
Company: G ✓°2,0-- 6&4p� rS
City: Vixk Q,e,rce- State: r�
Zip Code: 34 9 LK Fax:
Phone No. SU ( ^'159 . 5
,TrG•
Address: S« esu 0-
City:yoy-r Sk •l_,y Gt State: '�L
Zip Code: _? 4q :1 3 Fax:
Phone No '1'11, 33 - -7(_o'S-3
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail -TorM 6 Uru } r�(n�i,1�-er.S , Con'-
J Id
State or County License C CsG 15 ay-i3y
It 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 CONSTRUCTI N LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: of Applicable
BONDING COMPANY: _ of 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 ap attorney before cogmencing work or recording our Notice of Commencement.
�2 d'M4 Aro
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Signature of Iner/ Lessee/Contra for as Ag for Owner
-
Signa e of Contractor/Lice Ho der
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF �-�,+ LkAC%'C—
COUNTY OF_ S+U,LCi 2,
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
✓Physical Presence or Online Notarization
✓Physical Presence or Online Notarization
this 21 day of OP—Cg , 2020 by
this Zl day of OWO .AjQAA 2020 by
7�6\A_Q LL-J�� n,u C-, M-L0,
Name of person making statement.j
Name of person making statement.
Personally Known ll__/R Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
N M I
Produced
UN
O
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(Signatilfrtpotary Public- State of Florida)
(Signatur of tary Public- State of Florida) a N
Commission No. Q$ Seal z ¢
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Commission No. (Seal)
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REVIEWS
FRONT
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UP,'/
PLANS
VEGETATION
SEA TURTLE
AN, ,RQVE
COUNTER
REVIEW
R :` _
REVIEW
REVIEW
REVIEW
R P N
DATE;oH.....�
=,r
RECEIVED
DATE
COMPLETED
Rev. 5 6 0
PERMIT 4 I ISSUE DATE
I _
PLANNING & DEVELOPMENT SERVICES
fi Bufldiina & Code Coniphance Dhisior
j
BUILDING PERMIT
SUB -CONTRACTOR AGREENTENiT
Platinum Plumbing
(Company Name/individual Name)
the Plumbing
(Type of Trade)
have agreed to be
Sub -contractor for Groza Builders, Inc.
(Primary Contractor)
For the project located at 3433 Gordy Rd
(Project Street Address or Propery Tax ID #)
It 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
tiling of a Change of Sub -contractor notic
C'ONTR�C' ' R SIGNATURE (Qualifier)
PRINT N.ANIF
M H
COUNTY CE.RTiFICATION NUMBER
State of Florida, County of c:EIJUCiC.
The foregoing instrument was signed before me this L1 day of
OE QAtiAe , zo_ol>� oltif1 A�1 vLro�
�2 �-
w ho is persounih' k.nw it ^or has produced a
as identification.
Nrr
Siguatu o No ry Public
7SLo
nn
rn�
Print Name oi'Nulary Public
w o
Revised i I ' 16 2016
i
SUB -CONTRACTOR SIGNATURE (Qualifier)
��QW �- ll6 _ �' a
PRINT NAME
COUNTY CERTiFiCATiON1 NUMBER /�
Slate of Flurida, County or��a
UC i
The foregoing instrument was signed before me this 2-A day of
who is persomdly know'. or has produced a
Print Name
STANIP
OUNTi
F L O R 1 D A -46
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT
Aapex Electric
(Company Na111C/I11diVidl1al Name)
the Electric
(Type of Trmdc)
For the project located at 3433 Gordy Rd
hate agreed to be
Sub -contractor for Groza Builders,lnc.
(Primary Contractor)
(Project Street Address or Property Tax ID #)
it 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.
CONTRACTOR. .NATURE (Qualifier
�dn� �r.��.d..l Cam•-,��-zc___
PRINT NAM@
1Uod l,A
COUNTY CERTIFICATION NUMBER
State of Florida. Cmurti, of ,S+\.k i e—
SCB-CONTR:�CTOR SIGN:�TURE (Qualifier)
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PRINT NANIE
Ec 1 30oa 3(43
COUNTY CERTIFICATION NUMBER
State of Florida, County of S4 . W C
!'he foregoing instrument was signed before me ,t�h�is� 21 da}' of The foregoing; instrument icas signed before me this day of
2U h}��O�n rl`l 1�'VyOn 2� Q2Le'yY1V a= . 2u� by _ _ L 1� ""'l �'�c fJ Q
who is personally known k, ur has produced a who is personally known -,/—(Ir has produced :r
as identification,
signature o Not: ). 1'u
Print Name ofNot:ry Public
Revised II'162016
as identification.
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fj/Il{� ,-k STAMP
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:gnature of Notary Public
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