HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED /'�
Date: /a — 20 — 2/ Permit Number: `� V y — S 7�p
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Building Permit Application 4,419,,xvj
Planning and Development Services ]
Building and Code Regulation Division Commercial ResidentiAe-09 wo
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding a�Al�caa
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: 4625 S. Indian River Drive Fort Pierce, FL 34982
Property Tax ID #: 2436-331-0001-000-9 Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
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 _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: ',// ,JMi0 Sq. Ft. of First Floor: Id 60
Cost of Construction:$ 'T.�0O1-- Utilities: _Sewer _Septic . Building Height:
OWNERAESSEE:
CONTRACTOR:
Name Stephen Ferreira
Address: 5215 Hickory Drive
City: Fort Pierce state: FL
Zip Code: 34982 Fax:
Phone No. 772-302-4323 E-
Name: Douglas Sammons
company: Hall -Sammons Inc.
Address: 1101 NE Martin Avenue
city: Jensen Beach state: FL
zip Code: 34957 Fax:
Phone No 786-337-5107
Mail: cubbies4000(@yahoo.com
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail halisammonsinc@gmail.com
State or County License CRC1326546'
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
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
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 conflicts with any. applicable Homeowners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consu t with your Homeowners 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.
Signa ur of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORID/W
COUNTY OF T>/U
Swor to(�o affirm d a subscribed before me of Physical Presence or Online Notarization
this ��day of 20aLf by
m1nQ,
Name of persofl making statement.
/
V
Personally Known OR Produced Id ntification
on Produced i = .0 .
Type o7_Tsg_-�C_
Q -
(Si r f NotaryState of Florida)
jP'ublic-
Commission No. &3oLReal) yo�P.�`"pe�ip JESSEDOSS
1J
* * Commission # GG 263069
Expires September 27, 2022
Bonded Thru Budget NotaryServlcea
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DATE
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COMPLETED
Rev 5/20/21