HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST rBE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: // - S ` a0A! Permit Number:
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1 Building Permit Application
Plonning and Development Services
Building and Code Regulation Division Commercial Residential Y
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: 17 �X �� �� �Carr�oC. /�DD�/S/oi9 AIi1m cxiI
Address: 7T6-/ 1-9Z4 77W- 7"/G/7 L"E-5_ 4W
Property Tax ID #: 2 4 • QO/.3. ODO • y Lot No. � 7
Site Plan Name: Block No,
Project Name:��/'J�
DETAILED DESCRIPTION OF WORK:
/71x 4l0 �/7 �•Pour�oL ��aL Sow' �i�"ti C'o� �c.�
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION: I
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: %( , S Sq. Ft. of First Floor:
Cost of Construction: $ _S, &z D Utilities: —Sewer _ Septic Building Height:
OWNERAESSEE:
CONTRACTOR:
Name 5dleltl ir ew17/'e. &e
Name:
�,/�
Address: 11cY/Q�_ _
Company:
City: D 77 /ED
Zip Code: Fax:
Phone No. • 2
Address:
City:
Zip Code:
Phone No
7
7 '
Fax:
C
5 ate:z C
E-Mail: 064407-11KV/,1!� Q/ f jm2Ileal%!7
Fill in fee simple Title Hider on next page ( if different
from the Owner listed above)
E-Mail
State or County License
it value of construction is l5Uu 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 consu#t 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 *ull 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 comrWcing work or recording our Notice of Commencement.
Signature of Co trac o(/License Holder
Signat re of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF /19
STATE OF FLOP A
COUNTY OF
Swarp to (or affirmed) and subscribed before me of
V Physical Presence or Online Notarization
this �Oday of 2021 by
Sw n or affirmed) and subscribed before me of
P ysical Presence r Online Notarization
this 13 day of _ �o V 2020 by
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification ✓
Persorally Known #/ OR Produced Identification
Type of ldentification
Produced e 14r1�4[�J
Type of Identification
Produced
I
is,
/
(Signature gAotary Public- State ofFlorida)
(Signature of tart' Public- State of Florida)
j
Commission No. 6G 80/7l� (Seal)
! Commission No. G���QI �� (Seal)
E
I
REVIEWS
FRONT
ZONING
i
SUPERVISOR
PLANS
I VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 5/6/20
CtV01Y
D A -"
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
BUILDINC PERMIT
SUB -CONTRACTOR .AGREEMENT
xln S 67LEC72l G hay e aoreed to he
(Company Name'Indivioual dame)
the ELEC17W I C Sub -contractor for
(Type of Trade) (Priman Contractor)
For the project located at ?& V I91—/1" TW T/p 12 4,44eFx Z� 0C,
(Project Street Address or Property Tax ID 4)
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.
CONTRAC" OR SiGNATI'RE (Qualifier)
PRINT N"INir-
Cot NT9' CERTIFICATION Nt'NIBER
Stale of Florida. County of kT n
The foregoing instrument was signed before me this day of
who is personallF' known "' or has produced a
as identification.
D`Lci�
Signature otar} Public
Z ors �dlk_
Print Nance of Notary Public 1-01
Pur)!ic 3,180 of Fix: a
n'�i n GG 2W146
,..'FA'it3Y%+.f"FY�K`t rY tl�wi `ilk- Sr �✓l� `I�y+ry
Re4ued l 1 Ih-2016'
i
St'B-C SIGN#Ti'RE (Qualifier)
Rr cjC. 6(Z,4Ck-_�Rrc l
PRINT NAME
000 2 0-
C'ot'NT4 CERTIFICATION Nt NIBF.R
State of Florida, County of Af 71-1/
'The foregoing instrument was signed before me this Q dar of
v.24&
who is personalty known ' rr has produced:]
as identification.
SrA31P ST A%IP
Signatur,k6f Notary Public
e40rl , �' A
Print Name of Notary Public
�a
� v NOpry P';n,cc SM a
a Lni i A M nx,,41y
o h?y Gomrivzio, GG 2301; 8
k E;.jmes i _3rrcrzz
PER[OT # ISSUE DATE
PLANNING & DEVELOPMENT SERVICES
' = ' Building & Code Compliance Division
BUILDING PERNHY
SUB -CONTRACTOR A(� 'REEME.NT
�1PE Mlldw4-- PDo LS IQ`j� F/6ryy1') have agreed to be
(Compan\ Name Individual Nafne) �
the /41z,/Iln (j iQi Sub -contractor for /VEX cf- /;7z-s
(Type of Trade) (Primary Contractor)
For the project located at �7 ?4p ZI /IL 1117 7-4 TYD/I
ect Street Address or Property Tay ID R)
It is understood that. if there is any change of status regarding our participation with the above mentio ed
project, the Building and Code Regulation Division of St. Lucie Count will be advised pursuant to the
p J ., g Y
filing of a Change of Sub -contractor notice.
COti lt(-TO# Slf .NATt RE (Qualifier)
F(60 tq
PRINT NAME
C+PC I -[ 55&q&
COUNTI CERI IFIC,ATION NUMBER
State of Florida, Counth of
The foregoing instrument was signed before me this da} of
ov NV; b,
who is personally known _or has produced a
as identification.
SI OH,
Signature o . otary Public
L DO • /' - N
Print Name of Notar% Public
},
' n GCS 26, 148
Re,,ised II'Ibi?VI6
St WCO\TRACT IG\ATURE (Qualifier)
/� Y Fl 6
PRINT NAME
CO€ VIA CERTIFICATION NUMBER
State of Florida, County of / 198 %11�
The foregoing instrument Aas signed before me this _It dAN of
H'ho is personally known _cir has produced a
as identification.
STAMP
Signature rtf utary Puhiie
ate,j4. ffiLIZ21
Print Nance of Notary Public
Nr.t 4ry put�S,c Stata of F ior'da
Iair �.iWit� sY °�
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