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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
Lj�C�C�LL
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION;
Residential X
Address: 4235 N HIGHWAY A1A UNIT 9 For Pierce FL 34949
Property Tax ID #: 1423-120-0012-090-5 Lot No.
Site Plan Name: Block No.
Project Name: GRIM
DETAILED DESCRIPTION OF WORK:
REPLACE 6 WINDOWS + 1 DOOR SIZE -FOR -SIZE WITH IMPACT
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: $ 7464 Utilities: —Sewer _ Septic Building Height:
OWNER%LESSEE:
CONTRACTOR:
Name Randy Grim
Name: Roberto Sanchez
Address: 4235 N HIGHWAY A1A UNIT 9
Company: The Home Depot
City: Fort Pierce State: F
Zip Code: 34949 Fax:
Phone No. 570-439-4673
Address: 2455 Paces Ferry Rd
City: Atlanta State: GA
Zip Code: 33039 Fax:
Phone No 754-224-2010
E-Mail: stonyforkcreekcamp@gmail.com
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail robertosanchezthd@expeditepermit.com
State or County License CGC1522717
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.
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SUPPLEMENTALCONSTRUCTION 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: _ Not Applicable
BONDING COMPANY: Not 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 an attorney before commencing work or recording our Notice of Commencement.
Signature Contracto icense Holder
Lessee/Contractor Agent for Owner
Signature of Owner/ as
of
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF7� 1 d�6f Y
COUNTY OF S+, Luci t
Sworn to (or affirmed) and subscribed before me of
Sworyi to (or affirmed) and subscribed before me of
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
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REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.5/6/20
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