HomeMy WebLinkAboutPermit Revision 2103-0287OFFICE USE ONLY:
DATE FILED:
REVISION FEE:
LOCATION/SITE
ADDRESS:
PERMIT #- Z 03- OZ3-7
RECEIPT #
PLANNING & DEVELOPMENT SERVICES
BUILDING & CODE REGULATION DIVISION
2300 VIRGINIA AVENUE
FORT PIERCE, FL 34982-5652
(772) 462-1553
APPLICATION FOR BUILDING PERMIT REVISIONS
PROJECT INFORMATION
r
Lam-, f FL 3�1
DETAILED DESCRIPTION OF PROJECT
REVISIONS:
CONTRACTOR INFORMATION:
STATE of FL REG./CERT. #:
BUSINESS NAME:
QUALIFIERS NAME:
ADDRESS:
CITY:
PHONE (DAYTIME):
STATE:
OWNER/BUILDER INFORMATION:
ST. LUCIE CO CERT. #:
FAX:
ZIP:
NAME: m
ADDRESS:
CITY: P '7-\ c STATE: — L ZIP: 3gQg[7
PHONE (DAYTIME: 51 tf - - I I $ FAX.
ARCHITECT/ENGINEER INFORMATION:
NAME:
ADDRESS:
CITY:
PHONE (DAYTIME):
SLCCC: 9123109
Revised 06130117
STATE:
FAX:
ZIP:
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
PLEASE SELECT ONE OF THE FOLLOWING'
X 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.
l
Date. CL - 1 ZQ i Permit Number: Zl U 3 - OZ $ 7
Site Address: 2 � ' L 1.,rag
A> �A� �` State License SLC License
Original GC, subcontractor or owner/builder
nC-7 &, 1 State License SLC License
New GC, subcontractor
Reason for Cancellation
C c7�\C(A
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
co actor/subcontractor or cancellation of permit_ A permit cannot be cancelled if work has been performed.
/ . I � n
SIGNATURE 0FWWl4ER (or owner/builder) SIGNATURE GENERAL CONTRACTOR (or new GC, as applicable)
PRINT NAME S cG O PRINTNAME
State of Florida, County of St. Lucie County State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
day of S e Q k` . 20 z by �-rk
IX f u + u who is personally known to me
or who has produced as ID.
Signature of Notary Date
Revised 04/15/16
The following instrument was acknowledged before me this
day of_, 20— by
who is personally known to
me or who has produced as ID.
Signature of Notary Date
r:os'"Y+'r"'••
NANCYJOHNSON
Notary Public - State of Florida
10M
Commission t GG € t01MB
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OF IL
My Comm, EHpiroSep 23.202€
80n6cd Ihrdugh NdImnul NoLrrygs5n.
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date
Permit Number: 2i Z,
1�v
° LL h ° = 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 CBDG Funding
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: I - CC1
Property Tax ID #:
-7o
cD D �
20 QO Lot No. !
Site Plan Name: Block No.
Project Name: � [-(,\
DETAILED DESCRIPTION OF WORK:
POD —n ZJ k D k60
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
(Affidavit required)
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: 1,0 yo
Sq. Ft. of First Floor:
Cost of Construction: $ i Utilities:
—Sewer —Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
Name:
Address: _l $OCjI "�,nt�[ �� �
Company:
City: _ s-State: FL
Address:
Zip Code: SLIPS7Fax:
City: State:
Phone No.
E- Zip Code: Fax:
Mail: )�Gat�Cc Z� �� �.,�
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:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
r iAiwFR/ IYInITQArrnn A«1h►nT.
",% nrr,vv I I. App„cation 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 conflicts with any. applicable Homeowners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Homeowners 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 your Notice of Commencement.
if � U
Signature of O AnerLessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF
Sworn to (or affirmed) and subscribed before me of Physical Presence or Online Notarization
this - day of m 20-2-1 by
I5 0 CL Y-- CK
Name of person maki g statement.
Personally Known Z OR Produced Identification
Type of Identification Produced
(Signature of N
ry Public- State of Florida)
Commission No. (Seal)
REVIEWS FRONT ZONING
COUNTER REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev
dab
1rRY p .''
NANCY;OHNSON
,
NoraryPuillic State offlorida
+ i4-
Commission 0 GG 110108
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My Comm, ExpliesSc 23, 202f
Umledthrougfi.NatinnaiNoteryAssn.
S REVIEWOR REVIEW 1 VEGETATION
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