HomeMy WebLinkAboutAPPROVED REVISION 2103-0287 OFFICE USE ONLY:
DATE FILED: PERMIT# Z 03 J O Z 37
REVISION FEE: 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
LOCATION/SITE
ADDRESS:
r
C1 �• S ( C FL 11G4 S-7
DETAILED DESCRIPTION OF PRO.IECT
REVISIONS:
Qol e �am\ 2-4 1\60 x to
CONTRACTOR INFORMATION:
STATE of FL REG./CERT. #: ST. LUCIE CO CERT. #:
BUSINESS NAME:
QUALIFIERS NAME:
ADDRESS:
CITY: STATE: ZIP:
PHONE (DAYTIME): FAX:
OWNER/BUILDER INFORMATION:
NAME: �,cc �1� `xm 1 o
ADDRESS: 18M1 l�, 6m1ncrA
CITY: Pcr\ Sv Lue"c STATE: rL ZIP: 3g0I 7
PHONE (DAYTIME: 51 --Ito 5-S I I $ FAX:
ARCHITECT/ENGINEER INFORMATION:
NAME:
ADDRESS:
CITY: STATE: ZIP:
PHONE (DAYTIME): FAX:
SLCCC: 9123109
Revised 06130117
PLANNING & DEVELOPMENT SERVICES
- J ,v BUILDING & ZONING DIVISION
i r
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:
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 7 I z Q Z t Permit Number: 23 U 3— 0M
Site Address: ��M ot`a(1 n �NceA Lme sA L L-,e- EL 3uag 7
22Js AC s �ASLi State License SLC License
Original GC, subcontractor or owner/builder
0W Nes &.I \�<T State License SLC License
New GC, subcontractor I,
Reason for Cancellation ga\xc 7-r,c-1 �c�c�U Ga OC G n�\ (T C QmCQA(eA �`r
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.
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SIGNATURE 4OF R(or owner/builder) SIGNATURE GENERAL CONTRACTOR(or new GC,as applicable)
PRINT NAME_Ln�AJ Gc O PRiNTNAME_ _
State of Florida,County of St,Lucie CountyState of Horida,County of St.Lucie County
The following instrument was acknowledged before me this The following instrument was acknowledged before me this
_day of S e Q ,20 2-``,by rh lfl e>�I day of 20,,by
�j C cL who is personally!mown to me who is personally known to
or who has produced as ID. me or who has produced as ID.
� Z
Signature of Notary Date Signature of Notary Date
Revised 04/15/16 NANCYJOHNSON
.� Notary Public-State of Florida
. •= Commission t GG 110108
MY Comm ExPire5 Sep 23.2021
OF1V"` Bon&d through Nallnnal Nolary Assn.
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: 24 2
-I L
� \
° 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: - CC 1
Property Tax ID#: 70 (2 D 2-0 QO (a Lot No. 10
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
Coo\ -n Z k o k b
New Electrical Meter Second Electrical Meter (Affidavit required)
LCIONSTRUCTION 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: 140 yo Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: —Sewer _Septic Building Height:
OWNERAESSEE: CONTRACTOR:
Name - Name:
Address:_k$CCjl ��I � � Company:
City: — r State: FL Address:
Zip Code: SLIPS7 Fax: City: State:
Phone No. 546- -M-S UR E- Zip Code: Fax:
Mail: )CGat'CC N @. '\ r,-, 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: y 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 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 our Notice of Commencement.
if
A, , U,
Signature of 01&ner Less-ee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF SAC•I�C.e
Sworn to(or affirmed)and subscribed before me of Physical Presence or Online Notarization
this -tLh day ofseDX ADC r 202L by
Name of person maki g statement.
Personally Known Z OR Produced Identification
Type of Identification Produced
---1' ,4-'f_0 q
(Signature of Nofary Public-State of Florida)
� Yp NANCY;OHNSON
Commission No. (Sea)) *�_ aacayp'. Stat�offlorida
• ` • £s�mmi5s�orrPGGtiU7f78
'- Z oT; My Comm,ExpiiesSep21,2021
r
''•�06 a�, $gndld lhrougfi Nannnai No[ery Assn.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev 5/20/21