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HomeMy WebLinkAboutBuilding permit, new contractor All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED p, Date: Permit Number: RECEIVED 6r;vioue4 V SEP 14 2021 Building Permit Application St.Lucia County Permitting 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 i PERMIT APPLICATION FOR: PROPOSED IMPROVEMENT LOCATION f Address: &0 YZAC T't2 t 1/ a 8 2 Property Tax M#:� °� �, C�a 60 Lot-No'. Site Plan Name: Block No. Project Name: DETAILEDd DESCRIPTION C3F WORK z r 6 A— O-PQ f New Electrical Meter Second Electrical Meter (Affidavit required) ytq 09-- g ev-s � CO,NSTRUCTICEN> 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 I - Total Sq. Ft of Construction: Sq. Ft. of First Floor: . Cost of Construction:$ 1 5 ©O 0 Utilities: _Sewer _Septic Building Height: 01NNER/LESSEE p CONTRACTOR a a � Name 6 up, � �CJ �Name- Address:��' ►�,o-�-� 2 Company: l/ vl City: c.t State:I L Address: 54) Zip Code: _ _ Fax: City: �•L� S'7" �`� Stater Phone No. t5 56 57 Zip Code: .� Fax: E-Mail: dInLJ�' VtEnt2 �1-1&i Phone No 5 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. 2 ) ��� SUPPLEMENTAL CN5TRUCTf.ON LfEN LAIN fNFCfZfVfATIQN '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. Sigr4ture of Owner/.Lessee Contractor as Agent for Owner _ STATE OF FLORIDA ` COUNTY OF Sworn tp(or affir d)and subscribed before me of Physical Presence or Online Notarization this day of 2Q_-�J) by .LP V au ig R .� n Name of person making statement. Personally Known o uced Idati ica io / Type of Identification Procipced. _�WA IL IN, (Signs n of Notary blic-State o F orida) •'Y °l•� AUDREY B.HUMPHREY Commission No. (Seal) MY COMMISSION#GG300817 o•:y eoQ.' EXPIRES:RES:March 6,2023 Bonded ThruNotary Public Underwriters REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev 5/20/21 i r� r PERMIT# ISSUE DATE . t iPLANNING &DEVELOPMENT SERVICES Building& Code Compliance Division • BUILDING PERM LIT SUB-CONTRACTOR AGREEMENT 1< F Snydees Cooling and Heating, Inc. have agreed to be (Company Name/Individual Name) the HVAC Sub-contractor for I (Type of Trade) (Primary yContractor) For the project located at (�0 �a�►�0.-�tt�yl 4• (Project Street Address or Prope ax ID#) ,3��34gb� . oDa,N 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 i filing of a Change of Sub-contractor notice. I , - i ONTRACTOR SIGNAT (Qualifier) C TOR SIGNATURE(Qualifier) James Snyder PRINT NAME PRINT 1\�AME 26414 COUNTY CERTIFICATION NUMBER COUNTY CERTIFICATION NUMBER We of Florida,County of, U. 1 L C State of Florida;County of St. Lucie The foregoing instrument was signed before me this •day off�� Th oregoing instrument was signed before me this O day of 21D,'])J by e YV t .20jby V �Og1111 Ifl/►�® who is personalty known or has produced a / who is pe ono y lmown_or has produced a \\ �� e i as identification. �` 5P "q'gss*A/•• as identification. 'pQ~VARY4i•' i A AMP Signatu of Notary Pub' Signature of Notary Public J �.y.jB#uGbGtc2896 62 A V ed'Tf-,1 ®B?INg So ® ^�h•%'� Uaile [� Print Name of Notoky Public V / Print Name of Notary Public Revised I1/16/2016 i i I , i PERMIT# ISSUE DATE PLANNING& DEVELOPMEIINT SERVICES Building& Code Compliance Division IILlI1,I)ING P [t111,fI W.� SUR-CON"17 ACTOR AGRLENIENT have agreed to be (Coro)lny Namellndividual Name) the eta('C tr Sub-contractor for (T fie of TrsdO (Primacy Contractor) f or the project located at d ` 4 (project Street Address or Property Tax JD#)"-J 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 Sri 1 be advised pursuant to the Filing of a Change of Sub.contractor notice. CO. fR 1CrUR SIGNATURE(Qasrtlicr)- SU oN7 R'kCT IGNATURE(Qualifier) IA '� 1'Ctl.,'TNAhiL PRINTNA)IE ' COVY171'CERTIFICATION '1i41ItGR COUNTY CERTIFICATION NUINTVER t 1Atnte of Florida,County o[ j/(,C � 'Q, State of Florida,County of r The foregoing instrument%vas Eigned before rue this day of The foreoolag Instrument was signed t+cfure theth�is day of C/� .2tltry ` •L___���� n t 20 ,by flis+el Q " ' j r j w ho is personally known or tins reduced u }+ who fa personally known or bus produced a � 1,U. P Y � � P as Went i fica tion. as identification. MAW. b44A 'i t ,urc ofitintaryl't bli signature of Notary Public g Print Nxntc of Notary'ublic t'iul Nan .of Notary 'ublic AUDREY&HUMPHREY pp�►*"�` Y'(QY�` I�I`OQNz� ' Rotary Pubtic,State of Florica rr`' P IC r' Itf fA,`f C%�Pv'!ItP,,S, � CG 300817 � Commhsfon#}iN 37410 *• �q `?}` d� Comm.moires Au 30,10 A =;:• o "tPIRE`: ' •;,r�r� �1y B Rc6s,d i t.61,{etc .�r�. .o.. ry "�'rS i Weed through hatiMat tiatarr .cad„ BandedThruNola {-u�i,� • I ,I f :RMIT# ISSUE DATE i PLANNING&DEVELOPMENT SERVICES Building & Code Complianee Division - •AMMON_ 4 BUILDING PERMIT ,1 SUB-CONTRACTOR AGREEMENT ' 2nn�s:; +,u✓r►g..,i� have agreed to-be (Company NameLIndiWual.Name) .,the PLW.0 e4 Sub-contractor for (Type of Trade) (Primary Contractor) For Lis,project located at 3 G 0 R Atta2 A e J.o V4 0 :�- (Project Street Address'orProperty Tax ID#) It is un,erstood 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 filingoi a Change of Sub-contractor notice. VVISy^, C NTRAr ORSIGNAT .(Qualifies`); SUB-CUN C—TO R;SIGNATURE:(QuaIifier) PRIfiT NME PRINT N CGS -_ ,. G 1 �e ' COUNTY ERTIFICATION NUMBER 1 COUNTY CERTIFICATION NUMBER State of Florida,County of �1it t e- State of Florida,County of '�&e •� f S� The foregoi�g instrument was signed bet re:me Us p n day of The foregoing instrument was sig/ne�d�beforc me this,�J��day of by ,�l Yee rna r-" j n( L)- i ,20 L by t�7 MurN who is personally knuwn`or'has produced who is personally known_or has produced a I,►CflL .� as idenflfWtion. ` as identification. -1 j I . I STAMP Sigitatu (lotary:PubHe Signature of Notary Public ti � � 17) Print Name of Notary Pu tie Print Name of Notary Public j DALE S.VAN DER LUGT �Pv�tt� AUDF EY 13.HUMPHREY : a q, Notary Public-State of Florida , COMMISSION#GG 300817 Commission#GG 325607 i ,fi EXPIRES:March 6.2023s` M Commission Expires Revtscd 1I/16/201b �i iiii�a`� Y April S,2023. non3cdTbtuNotary Publi!00aaerwnters i I i i Planning&Development Services Building&Code Regulations Division 2300 Virginia Ave. • R I . A Fort Pierce,FL 34982 - (772)462-1553 Fax 462-1578 CHANGE OF CONTRACTOR Or Subcontractor or Cancellation of Permit Change of Contractor is to be completed by the property owner, and the new contractor of record for the current pen-nit. A new permit application must also be completed with new contractor information, signature, and transfer fee. A new Notice of Commencement must be filed in the new contractor's name for job values greater than $2,500 ($7,500 if A/C Change-out). A recorded copy must be submitted prior to commencing any work. Subcontractor changes can be completed by the general contractor. Absent extenuating circumstances, a cancellation of permit is to be executed by both the owner and qualifier of record. Date: D /t ( 2 Permit Number: Site Address: &ne10�1c!$tate License Ll S 265 s-Q License t Original General Contractor(or Subcontractor) Ylrl 0-a- Q- C• � 5e,�i tcense j2 G� 9 SLC License New General Contractor(or Subcontractor) 6Z8 Reason for Change. The undersigned does hereby agree to.indemnify and hold harmless St. Lucie County,'ifs 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/subcontractor or cancellation of permit. A permit cannot be cancelled if work has been perfo ed. SIGNATURE OF OWNER (or owner/build ram) ' IGNATURE ZLJ EW G�7,0_f E CONTRACTOR PRINT NAME PRINTNA4IE r State of Florida,County of St.Lucie County State of Florida,County of St.Lucie County The following fi" instrument was acknowledged before ymee this The following instrument was acknowledged before me this Qb 'day of Se 12� P1b '.20 L4,by �10f10L I UA, day of ,20_,by who is personally know to me who is personally know to me or who has producedp as ID. or who has produced as,ID. Signature of Notary Date Signature of Notary Date I *Only signature .required for change of subcontractor RECEIVED Revised 07/21/14 DALE S. VAN DER LUGT SEP 14 2021 Notary Public-State of Florida °+ +_ Commission #GG 325607 St.Lucie County -my p i Commission Expires Permitting April 18; 2023