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HomeMy WebLinkAboutBUILDING PERMIT APPSAll APPLICAI3 E INf O MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: �� Z Permit Number: S', LU,C127. Building Permit Application Planning and Development Services Building and Code Regulation Division Commercial Residential .2300 Virginia Avenue, Fort Pierce Ft 34982 Phone: (772) 462-1553 Fax: (772) 462-1578 PERMIT APPLICATION FOR; VOQ PROPOSED IMPROVEMENT LOCATIOpN: Address: O �arn6 10� �l� Property Tax ID #: QqI',50,5' 0 60& • 000 - & Site Plan Name: rn 9 UU SF Project Name: C 1� ©u Lot No.�_ Block No. I DETAILED DESCRIPTION OF WORK: I New Electrical Meter Second Electrical Meter I CONSTRUCTION INFORMATION: Additional work to be performed under this permit —check all that apply: —Mechanical — Gas Tank _ Gas Piping — Shutters — Electric Plumbing 4 —Sprinklers /JI[ Total Sq. Ft of Construction: 17 U — Generator Sq. Ft. of First Floor: a0176re be- (Ye Windows/Doors _ Pond Roof Pitch Cost of Construction: $ Utilities: Sewer Septic Building Height: OWNER/LESSEE: CONTRACTOR: / Name 7 Name: %� Fia Al% Address::y �i0e 19 �/� Company. 'iPJFX v�Ps 4- �0� City: FL C-e— State: Zip Code: �1 Fax: r�� Phone No. 1 • / ' U J_A Address: 5� City: Zip Code: Phone No11A State: z— Fax: •y�/ ✓��� • �V✓� E-Mail: 4gouSle�2_. /%i C� Fill in fee simple Title Molder on next page ( if different from the Owner listed above) ,, �, / E-Mail �. QX� a ixes. ce/'v State or County License It 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: V 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. Signatur of Owner essee/Contractor as Agent for Owner Signa re Co ctor/License Holder STATE OF FLO IDA STATE OF FLORIDA COUNTY OF COUNTY OF Sworn (or affirmed) and subscribed before me of Physical Presence or Online Notarization this , ,3day of � X ®.�, _;; �02J by Swor o (or affirmed) and subscribed before me of Physical Presence or Online Notarization this o ay of 2021 by Name of person making statement. Name of person making statement. Personally Known OR Fir duced Identification Type of Identification Produced e onallv Kn Y OR Produced Identification Type of Identification Produced (Signafi of Notar( Public- State ooff Florida ) (Signat of Notary Public- State of Florida ) Commission No. �/�Td (Seal)`, i3_ 'E Y Nuu c S ma of Ffar;da Commission No. Ne'i :iie.a of Rohde REVIEWS FRONT ZONING SUPERVISOR,,' PLANS VEGETATION .., .SEA.TURTLE MANGRQVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev. PERMIT # ISSUE DATE COUNTY F L O R I D A PLANNING & DEVELOPMENT SERVICES Building & Code Compliance Division BUILDING PERMIT SUB -CONTRACTOR AGREEMENT A0E1r Pit%&eS (Y have agreed to be (Company Name/Individual Name) the Sub -contractor for (Type of Trade) (Primary Contractor) For the project located at /.30y /7,,_P / 691/)e— ,Z >, (Project Street Address or Property Tax ID #) ' • Farm , �/`enc'4z FL 3,4 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 SIGNATURE (Qualifier) A& Flb-mm PRINT NAIVE COUNTY CERTIFICATIONNUMBER State of Florida. Count)• or / /%A-r� The foregoing instrument was 21t4�! signed ore me this � day or Aby �A/ff1'/ who is personally known " or has produced a as identification. dk 6-/. STAMP Signature otary Public Print Dame of Nutary Public SUB -CONTRA TOR GNATURE (Qualifier) _. 9 &_0 F16NIM PRINT NAME COUNTY CERTIFICATION NUMBER State of Florida, County of The foregoing instrument w� as signed before me this �dayy of 2p;_/�/, b�) who is personally known �! ar has produced a as identification. 5 S"rA!4I P Signature of:' Lary Public Print Name of Notary Public yr r, ply. ; y I'ucuic :;G?t,^ of Finrkda MEE] jc Ste a of FondaI rn i A t"I0. :} xley_ 2y01<:ii i-�ioi} G ; 26014612a12022Revised I I/1h/2016 a#r rir"41Sf�/�n PERMIT # ISSUE DATE COUNTY F L O R I D A PLANNING & DEVELOPMENT SERVICES Building & Code Compliance Division (Company Name/individual N me) the ELECTIZI ef4L (Type of Trade) BUILDING PERMIT SUB -CONTRACTOR AGREEMENT /Z have agreed to be Sub -contractor for 'Olp"a (Primary Contractor) For the project located at /3Dy G.o11e P%/IQ (Project Street Address or Property Tax ID #) Wel!� 3 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. CONTRACT R SIG 'ATURE (Qualifier) RY,4fl Fr Gfil Ar) PRINT NAME 0,P11 W -96 9 COUNTY CERTIFICATION NOIRER State of Florida, County ofvp&dlsz The foregoing instruments was signed before me this.23 delay of -e. .211d5/, by '/// �-1e5//1Ae? N hu is personalty known _or has produced a as identification. Signature 'of Nsoary Public Print Name of N`otan' Public SUB-CONTRAC OR SIGNATI E {(Jualirier) &,!Ad e/ L • �Dru fZ PRINT NAME C—c 13 D0& -339 COUNTY CERTIFICATION NUMBER State of Florida, County of The foregoing instrument was signed before meee this 2—fdac of � y�A�u//% who is personally known L nr has produced a as identification. STAMP Signature idtNotary Public Print !Same of Notary Public �, ,a; r•. , Ir!ary Public .` i:wa of F:crda j cr Lot i A Mo;b':y 1Yy C�mmissian GC; 60'I48 Rc%'ised 11116/2016 ''r, ="N& Expea 111213120<2 y3 ,r'�T r �fo!ury Putslic 5!�t3 of f:i,::de !" � ss�; i_ori A P+for!�y a 5/iy Cnmmssion GCS Z°0148 Trot rs�' E.'pir�a 11!2%ir�022 STAMP