HomeMy WebLinkAboutBuilding Permit Application-updated to owner builder All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �y
Date: JUL 2® ZO& Permit Number:Ln i
��n ����St.Lucie Cngnty
a"mli lie
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: 910 AI�Ti�1�N U. APIC CE,a 3)19Y f
Property Tax ID#: 210 9- 3 3- 0Q01-000-g Lot No.
Site Plan Name: Pg1/L 43'0%TARX Block No.
Project Name: PAUL. 601TARDO
DETAILED DESCRIPTION OF WORK:
�30 X 60X /1 Jr-1/L/0 ED <JErI BUIL11-TN4 OAl N,9W eQi4,C,v F Ar lAebk&MALVcc
New Electrical Meter Second Electrical Meter (Affidavit required)
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:$ Utilities: —Sewer —Septic Building Height:
OWN ERAESSEE;: CONTRACTOR:
Name PLII,CL 6077Aeb0 jtX Name:
Address: ^QQ hAP_7AIAIN RD Company:
City: FT. PUR4F_ State: F1 Address:
Zip Code: 3-#!ZY1 -Fax: City: State:
Phone No. 112- #61- 5.219 Zip Code: Fax:
E-Mail: PAILL 66TTAQ_b03 AD 9MATL .40M Phone No
Fill in fee simple Title Holder on next page(if different 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 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: 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.
4: - 4JJ04& AI�E
Signature of O ner/Lessee/Contractor as Agent for Owner
STATE OF FLORID
COUNTY OF �-
Sworn to(or affirmed)and subscribed before me of Physical Presence or Online Notarization
this ' day of 20_ by
Name of person making statem1ent.
Personally Known OR ProduWA Identification
Type of Identification Produced
tPA
(Signature of Notary Public-State ELLEN VAUGHN
1�Y PVB
q
l �o y tate of Florida-Notary Public
Commission NGo� =': l Commission # GG 270079
M Commission Expires
'%/FOF FIO` OC.t�VeL4.L�o2.2
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev 5/20/21
PLANNING & DEVELOPMENT SERVICES
' - BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772) 462-1553 FAX 462-1578
CHANGE OF CONTRACTOR, SUBCONTRACTOR OR CANCELLATION OF PERMT
PLEA OE SELECT ONE OF 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 PERMIT—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: �2O L 1 Permit Number:
Site Address: 90-1—ly o-0 �Q
—A P i erc.e -1l. 3Y9J1 1 State License SLC License
Original GC,subcontractor or owner/builder
So I f State License 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
contracto s bco tractor or cancellation of permit.A permit cannot be cancelled if work has been performed.
71,14�
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SIGNATURE 6V O. (or owner/builder) SIGNATURE GENERAL CONTRACTOR(or new GC,as applicable)
PRINT NAME PwA(J V k IJ V PRINT NAME
State of Florida,County of St.Lucie County State of Florida,County of St.Lucie County
The following instrument was acknowledy e¢�bef¢� e is �� The following instrument was acknowledged before me this
ZQh of�1�202J b 1W day of 20_,by
who is personally known to me who is personally known to
or who has produ as ID1 L V L me or who has produced as ID.
Signature �e�; E LA,&q VA U G H N Signature of Notary Date
=State of Florida-Notary Public
_y {_
a"�� Commission #GG 27007q
°,0 MY Commission
Revised October Expires
22, 2022 ,