HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 7-43-c:?, 4-RZ
Permit Number:
`r, L Lr CLL.
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:
PROPOSED IMPROVEMENT LOCATION:
Address: J5 9 BEL FRY /01- Q/-f St
Property Tax ID #: 4. 7- 7o/' mI-ldg • QQ 0. 9 Lot No. y9
Site Plan Name: c�
%( Block No.
Project Name: 3
I DETAILED DESCRIPTION OF WORK: I
Iy" yA 5,117 �/'0ll/J4 PD4/ lvith 1,X 7' g CO/26pe dP illa
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit - check all that apply:
Mechanical
✓Electric
Gas Tank
1%Plumbing
Total Sq. Ft of Construction. -377
Cost of Construction: $ -5,6 A d
Gas Piping
Sprinklers
Shutters _ Windows/Doors _ Pond
Generator _ Roof Pitch
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic Building Height:
OWNS /LESSEE:
CONTRACTOR:
Name JEFFM uR 1,4
Name:
161AM
Address: Jr' y9geZ C
Company: NEX pfil/ys4-
City: kv& State: r'-G
Zip Code: ,3 Fax: Q
Phone No.d
Address: 5 ec
City: 1/111 %
Zip Code: 99y
Phone No J11g• 11/9
Fax:
5/5/
State:JL-
E-Mail: �ccrnl'a 2 D00vA C
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail I "' 0X,✓6a
0 -;�p2j(12-,>JIMS.
C e90
State or County License a;y
I q55& 941
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 CONSTRUCTION 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: VNot 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 l 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 of 0Veer/ Lessee/Contractor as Agent for Owner
Signature of C ntractor/Lic se Holder
STATE OF FLORIDA
STATE OF FLORIDA -
COUNTY OF /}2Ale7//�
COUNTY OF
Sworn° (or affirmed) and subscribed before me of
Swor (or affirmed) and subscribed before me of
YPh sical Presence or Online Notarization
Ph cal Presenc or Online Notarization
this day of 201 by
this ay of 202fi by
E �N•�
R y�� F���A� ���..
Name of perscWrnaking statements`:
Name of person making statement.—
_%aA
Personally Known OR Produced Ide itoatim6h
a�
Personally Known OR Produced Ides ifi a�tiar
Type of Identification 2
Type of Identification. o A
Produced T� =
Produced a
_
9 Cr
(Signatur of Notary Public- State of FI rida }� �a�
(Signatu of Notary Public-- State o,f/ Florida) ^'N
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Commission No. �� a�V01TaQ (5e)
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Commission No. (5 I)
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.
PERMIT # ISSUE DATE
COUNTY
F LORI D A
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT
j014/E.CS S — iQ44 F/6/1411e? have agreed to be
(Company NamelndividLlal Name)
the R goen lob 7 Sub -contractor for
(Type of Trade) (Primary Contractor)
For the project located at 85y ?_,i!FL FkPL - Po/`tl- St Loci e 3 9f4
(Project Street Address or Property Tax ID #) -33-?7.'7Q1. dQrf(v .O0D.9
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 SI i'ATURE (uOficr)
Y. F/ G/YIf!/'�
PRINT NAME
C l0C / 4/'ff&��c
Col NTY CERTIFICATION Nt NIBER
State of Florida, County of/9�
The foregoing instrument was signed before me this Jj day of
21by
is " son per:dly known �rr has produced a
as idelild-147ation.
urc if Notary Public
Loft A *Mq
Print Name of Notary Public
M ;�
Sl"B-CONTRA . R SIGNATU (Qualifier)
FYr4f1 FlGmFlo
PRINT NAME
COUNTY CERTIFICATION Nt NIBER
State of Florida, County of /
126LUO
1194L
The foregoing instrument was signed before me this i:T day of
2Q /by 91 06?nd�
who s ona,b
pers lly known t/ or has produced a
as identification.
STA NI P STA 11 P
Signature of otary Public
L o�, 1.
Print Name of Notary Public
?AY Notary Public Stets of Florida
4 Y Pr. Notary Public `state of Florida � I
p � Lori A f,Aa:cey
? Lori A Mai!ay N o Kly Commission GG 280148
tray Gomm awon GG 280148 � ?� �; Expires 1112W2022
am
�d�,r-act Expires 11/28/2022
Revised l I/16i2016
PERMIT # ISSUE DATE
COU NTI
F L O R I 1<7 A
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT
k2 5 Ael c& 6mof fie,
(Company Name/Individual Narnef
have agreed to be
the 61CC7i /G Sub -contractor for flip" `4W e,CS y- FfOOGS
(Type of Trade) (Primary Contractor)
For the project located at $s1/9 E1-_F_gy Pi- Pxi Sf G(Jcle, 2��8�
(Project Street Address or Property Tax ID #) 33a7. 7D/.
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 notice.
C0NTlU%C`T0R S CA�rURFalifierj
RY41'1
Ff camp
PRINT NAIVE
cP� 1'15hq(9&
COUNTY CERTIFICATION NUMBER
State of Florida. County of Ile %112
The foregoing instrument was signed before me this ay of
?tlq/ by 14
who is personally known Zor has produced a
as identification.
Signature d Notary Public
Print ?Name of Notary Public
�sr w, Notary Public Stan of Florida
Lori A Mwd y
.n c` k4y commission GG 280148
Expires 1112812022
Revised 1 1 /16/2016
SUB- O: SIGNATURE (Qualifier)
R/ e/,-- gwA CKeP&ir_6
PRINT NAME
COUNT} CERTIFICATION NUMBER
State of Florida, County orj�_T`/%J
The foregoing instrument was signed before me this 10— day of
204by�Ric/-- '61C1qC1<-eAr16r J
who s personally known 1/ or has produced a
as identification.
STAMP
STAMP
Signature of Nr ary Public
,<of/ , X
Print Name of Notary Public
d Y h�C Notary Pubji c Stale of Florida
? Lori A Moxley
o� My Commission GG 280148
Expires11123l2022