HomeMy WebLinkAboutChange of Contractor ,All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: 5 L C a I o_�- 0 3 I l
'u -LLMY U� �.._ RECEIVED
Building Permit Application
NOV 12 2021
St.Lucie County
Planning and Development Services Permitting
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: d'F
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Address: '3g30 S. Qces:n br. -TeA5-h 13egc�
Property Tax I D#: 3 5 2-2-- 6 D 3 - t 01 D - o o o16 Lot No.
Site Plan Name: Block No.
Project Name:
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New Electrical Meter Second Electrical Meter (Affidavit required)
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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: Sq. Ft. of First Floor:
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Cost of Construction:$ Ci, 43 + y Utilities: _Sewer _Septic Building Height:
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Name W grrt*J 't A iV%o- J-nhhson Name:
Address: S. 0 c��h �r. Company: f w', �S (?�,�i ,:.te;� S U�r S�,viccf LL
City: J en s�� 0 eg JA State: Fl• Addre`ss: 0 lb"?S "
Zip Code: 3 `rg5 Fax: City: Pit Si- LLL(:0 State: 1`1-
Phone No. C 10 9 3S - 5) 3 4- Zip Code: 3 q 4 8$ I o8S Fax: (�3-1) 9 o - 9431
E-Mail: Phone No C.-HO 3 No -o s6 G
Fill in fee simple Title Holder on next page ( if different E-Mail e�sl,��erser vi cEs k, ;J. c o w.
from the Owner listed above) State or County License 32l —1
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.
OR
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 commencingwork or recording our Notice of Commencement.
a ure of contractor-or-Owner Builder as applicable
STATE OF FLORIDA
COUNTY OF
Sworn to(or affirmed)and subscribed betre me of Physical Presence or Online Notarization
this day of 20 by
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Name of person making statement.
Personally Known OR Produced Identification
Type of Identification Produced pL
(Signature of Nota ublic-State o F
`,r DEANNA GIVENS
Commission No. `?f �� Notary Pug ate of Florida
•d� Commi3sio��HH 0863,2025
�. e` Comm•Expires Jan 28,
tzv�OFar' MY Assn,
Bonded through National Notary
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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