HomeMy WebLinkAboutBuilding Permit Application, Updated (Lisa Field) All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: -D2)� i
07n[LUC0E
wilding Permit Application
Planning and Development Services '
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue,Fort Pieree.FL 34982
Phone:(772)462-1553 Fax:(772)462-1578
PERMIT APPLICATION FOR:
PC►FOSED IMPROVEMENT LOCATION '
; . .
Address:,
Property Tax ID:#: C)SO --C7 __ram Lot No.
Site Plan Name: Ej ' C11[1A Block No. r
(1 "f Project Name: -
DETAILED DESCRIPTION`0F2WORK �• ' £
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LA ' .i'T Y;Z��'1 I `>t�I �^, �, �F�� cat"i rGt
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New Electrical Meter V"' . Second Electrical Meter.,
CONSTRUCTION INFORMATIONy Y
Additional:work to be performed under this permit-check all that apply:
_Mechanical _Gas Tank —Gas Piping /, hutters indows/Doors —Pond
_Electric JZPlumbing _Sprinklers _Generator Roof r .Pitch
Total Sq. Ft of Construction: c D-N& Sq. Ft. of First Floor:
Cost of Construction:$ Utilities: I-Sewer Septic Building Height: 1 i
OWNER/LESSEE ;CONTRACTOR 'T
_
t_ 1 i
Name t lt� i ` iPl j }' Name: 4 iS J�,kV �f v') 'Hf it(
,Address: r !aJ:5 Irkt,o Company: L ' ice'
City: S�1,t d r - State: Address: _:�.j 9S ba-an c)I
Zip Code: i I; (4 Fax: -7 -'o r�-q Y-,� City: 'i to Stater
Phone No. �a c . .? t Zip Code L4(1..Ce Fax:
,E-Mail: IK' )0`r-i;4"jfA rpi)e_ o i" iY r 1t x' 9• t 1 Phone No '1�{�. - j
Fill in fee simple Title Holderon next page{if different E-Mail 1�;` Gl i i� ' sCf"3 'a (-"CCi
from the Owner listed above) State or County License CA k^—' 12
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.
SUPPLEMENT AL�ONSTR' "110N LIEN LAW INFORM,4TION j '
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 apermit to do the work and installation as indicated..
I.certify.that no work or installation has.commenced prior,tothe issuance,of a.perii it.
St.Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which lsin-conflict with any:applicable Home Owners Association rules,bylaws°or and coyenanfsth'at mayyrestrict 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 here by'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.resuit 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 onthe jobsite;before the first inspection. If you intend to obtainfinancing, consult
With Ierider..gr an'L torne before commencin work or. recordingour Notice of Commencement.
a
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor./License Holder -
STATE OF FLIDA STATE OF FL
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COUNTY OF (Q,Y t 1'1'` COUNTY OF ,
Sworn to(or affirmed)and subscribed.before me of. Sw rp to(or affirmed)and subscribed before me of
Physical Presence or Online Notarizationhysical Presence or Online Notarization
th i day of k �-( 2620 by this�day of 2020f by
e__J
Name of person making statement: Name of person rnaki tatement.
Perso N:y Known OR Prod ed Identification Personally Known OR Produced Identification
T e of Identifier ion / l en 'fication r'
roduced a: 1 Produced
f
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(Sign _
a e of Public- tate of Florida) ( a
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CommissiNotivy
on t? r" eal) C •N' ao�57aa'A al)
, r My lla:q ps to arfi/ ` > b4MrA'023 NN
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REVIEWS FROM NG SUPERVISOR PLANS VEGETATION 'SEATURTLE MANGROVE
COUNTER R, a EVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE -
COMPLETED
Rev.5, _
05-21-'21 11 :28 FROM- Rena r Homes 772-692-9155 T-026 P0001/0003 F-219
PLANNING & DEVELOPMENT SERVICES
BUILDING&ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772)462-1553 PAX 462-1578
CHANGE OF CONTRACTOR SUBCONTRACTOR OR CANCELLATION OF PERMT
PLEASE SELECT QN8 OP THE FOLLOWING:
CHANGE OF CONTRACTOR-Change of Contractor is to be signed and notarized by the property owner,
and the new contractor of record for the current permit.A new permit application must also be completed with new
contractor information and signature_ A new Notice of Commencement must be filed in the new contractor's name
for job values greater than $2,500 ($7,500 if A/C Change-out)- A recorded copy must be submitted prior to
commencing any work_There is a$50.00 fee for the Change of Contractor.
CHANGE OF SUBCONTRACTOR-Subcontractor changes are to be completed by the general contractor.
The new subcontractor must fill out a Subcontractor Agreement Form.There is a$50.00 fee for the Change of Sub-
Contractor.
CANCELLATION OF PEWWT-The cancellation of a permit is acceptable only if no work has been done.
Cancellation of permit is to be signed and notarized by both the owner and qualifier of record. There is no fee for
cancellation of the permit.
Date: O 1 Permit Number: a J-0147 q
T
Site Address: �v (9l 1m 17t'�,zp_S „F-+. P rGe �1
G 1 ,nn DJvJ l State License lip.. O I Z(vf 7,AC License
Original GC,subcontractor or owner/builder
Nafm rn 11 C-iJ State Licensebf _17.( A qCj SLC License
New GC,subcontractor
Reason for Cancellation)
The undersigned does hereby agree to indemnify and hold harmless St Lucie County,its officers,agents and employees from all
costs,fees or damages arising from any and all claims of action for any reason,which may arise as a result of this change of
contractor/subeo otor or cancellation of permit.A permit cannot be cancelled if work has been performed.
b QNATUR F OF OWNER(or ownneerlbuillder SIGNATURE GBNI?RAL CONTRACTOR(or new OC,as applicable)
PRINT NAME �. l- L- [ PRINT NAME �^iSCL- /q P_ l
State of Florida,County of St.Lucie County State of Florida,County of St.Lucie County
The following instrument was aclatowledged�before
�me this following in went was aclmowlcdg b�forc me this 1�
day of 20�by L-r_�a- zoo j by •- L
I
ti o i ersonally kn .t me who is etsonall, to
or who ro �30e as ID. me who as uc ass Im,
2� DL
Signa re of Notary Date Sig ro of Notary Date
Revised 04/15/ wtyW
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