HomeMy WebLinkAboutBuilding Permit App - bob o'link way All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
s'u, Ll!c;ur
" L ` t` L L" 6� _ 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: -N3� C50b 0 UnV (A)Cg6 �(f 4LUCK L( LIg90
Property Tax ID R: 3 Sao - . sos - CxJ37- C')Do —co Lot No, Z8
Site Plan Name: fYt Cti CA S ) OnPi ( Pe) c4 L -t l ( C)C 331 Z__�UL 44 lock No.
Project Name:
DETAILED DESCRIPTION OF WORK:
IY' S1 C,LI1 2l'cCAYiC- hCOL+ P(-tAYl (J
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 gPlumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ 2ZCC7 OC) Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name FCA�X o Ld Mc)(.tCt -PILl,o, Name: 7b'�P— r7Qs')VfC-�\/ `
Address: 7+2 7 f2[ () U✓LIL IJ Xi t_ Company: I-)Cc S Ayu S f)WI ,S2rJLCeTrLL.
city: 1Lx1 state:-- Address: 2`70G ( AC- GII�C�J rXwe-
ZipCode: 7;Y C! g(, Fax: n(Gt City: '7�fi yler2C- state:,fC
Phone No. �7� �� l Z E- Zip Code: C(o ( Fax: 772- I ZZ
Mail: n( 0, Phone No -7-72--J�7,; --S(e 07
Fill in fee simple Title Holder on next page (if different E-Mail V YQV-e Ct�2I uc yl Chi � �(CL�w • M
from the Owner listed above) State or County License CP-- I L f S C4 p-73 CSC
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 TITLEHOLDER: _Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
t 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 your paying twice for
improvements to your property.A Notice of Commencement must be recorded 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
x X
i natur of Owner/Lessee/Contractor as Agent for Owner Signa re Contractor/License Holder
STAT FLO DA STATE O ORIQA
COUNTY OF � �5 ��5 COUNTY OF cA-C
The forg ing instrume was acknowledged before me The f rgging instru t was acknowledged before me
this day of by this LdayOf 2oJk by
Name of person making statement i� ame of person making statement /
Personally Known OR Produced Identification Personally Known OR Produced Identification 1/
Type of[den Type of Ide tiff ti
,i i a '
Produced v_ L Produced
I
(Signatureof Not Pubh - rida (Signature'of Notary u to da t Ly p ,,F f tRWi 4
Commission No. [� S af'LFgP ''$T�� ission No. :3� i°,(I ealrj ur n$FF9
n ' 11z
1'oty o ;�u o7 b'da
c'0
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17
( PERMIT K ISSUE:DA:iC-
PLANNING & DEVFLOPMENT SERVICES
Building & Code Compliance Division
- BUn,DINC 4'1?RMI.1'
SUB-CONTRACTOR AGREEMENT
r
Y 1��`IG_k__rct &i-�'f�G L L ._ ------ J.tOla£,--(' . A K havc agrccd to be
(('utlgmny N unc/Indivi(iu d Mum)
tile._ C( -�( I�N�_ [rjC'!-o - Sub-contractor I'or
(Type at'I'rade) ( ll man ty.,tContractor)
For the project located at —7`'t3 / 66b. (1 L,Ar k-. __Loud- _ D_�� S�- l I
WrojcCI Succl Addres's or Property I Ix W 1!) 34Q 21
CP
It is understood that, if there is any change of status regarding our participation with the above rneritioned
project, the Building and Code Reguilation Division of St. Lucie County will be advised pursuant to the
filing of a Change of Sub-contractor notice,
I
CON'1' -2 SL :�' '1' IC(f/lilicr) SU0-CONTItAC'fOR SICNA'1'11RIi(QnnNller)
I'Ill S"1'NANII? PRINT NAME
lC150ot27S
1'UI'A'I'1'Ch:R 1'II+ICA'I'IDN NIIMRT'R--- --,--�— COUNTY CERTIFICATION NLINIBER
Stab n1 El 11 id;i,County of_Sq l-iJ �k't ��q Slate or Florida,Cnnnly of_
rr'1'hs 'orepn og inslruutnnt u'us sign d 6e1'arc one this.. Any nl' The rnrcgoing insu nncnl was signed before me this_ _tlay of
Vu'Irl _ .-.zarlq'_ 6- �Lr7—T )�g�11''1f _ ,zo ,t,,r—__ -.. - _ .
who is persaloray known___m'lins produced a I A k t,1[{-S I C>C..y a will,is persoonlh hnoe n ,or has produced n.
o'W.11lit-walioll. as idcnlilicalloo.
� rS:rANIP _. _ STAMP
Signnlure 11l', a my Pt Ic C� Slgnnnrce of Nuhuy Public--
Print Nnnw of Aomrr Nn!'!iC ------ —�� �Print Nnmc of Notmry Ihthlic _---�-----
,j;:.••. NEHEMIAH M.WAGNER
MY COMMISSION%GG 001402
£Ma µ
E%PIRES:June 13,2020
Revised 11/1 61201G Rpnw Tye NObly Pubk Wldcrndlen
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