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Home My WebLink AboutBuilding Permit All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: _ �D�>y O��( Permit Number: A4unoo®lonq•ls �'o ZZOZ T ti �b'W ' Building Permit Application 3N3D3a Planning and Development Services 9 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: Address: RqJS MU11-1'glcin C 1 �{R o Pori Jain} 1-taLte, 31 40 (D Property Tax ID#: ? '-� _ 50,;L -'O t-t -O O n Lot No. ~-7 Site Plan Name: Block No. Project Name: .. aF,ctPT :=0 ,11Q R Ll0New Electrical Meter Second Electrical Meter (Affidavit required) 0 — 0 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: Cost of Construction: $ q " Utilities: _Sewer _Septic Building Height: --------------------------------------- 40WNL- /LESSEE: Name_ ka E Name:_ t �O Y\ Address: g ki 15 ML.t11 tcictft C» u� Company: �O �'10 City: Por---�- 5"I VOr L4C'I$ State:C-L Address: I viol Gnre'E'11\ CQ Zip Code:34(:�6(V Fax: City: P t'orz ko State: IP�- Phone No. E- Zip Code: 310GL4 Fax: Mail: _ Phone No 4"7t.t-1-"1-;.SI S Fill in fee simple Title Holder on next page (if different E-Mail5yajqeH4 �i W►^1�55 m r r s e-C.cly,% from the Owner listed above) State or County License C F C 1 -12�C3�q 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. 1 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 conflicts with any applicable Homeowners Association rules, bylaws or and covenants that may restrict or prohibit such structure. Please consult 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. Signature of Contractor-or-Owner Builder as applicable STATE OF FLORIDA COUNTY OF Sworn to(or affirmed)and subscribed before me of Physical Presence or Online Notarization this day of ,20_by Name of person making statement. Personally Known OR Produced Identification Type of Identification Produced (Signature of Notary Public-State of Florida) Commission No. (Seal) REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev 10112121 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 conflicts with any applicable Homeowners Association rules, bylaws or and covenants that may restrict or prohibit such structure. Please consult 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. Signature of Contractor-or-Owner Builder as applicable SYMONENA NICOLE SIMMS ;4 _Notary Public-State of Florida STATE OF FLORIDA ®P Commission N HH 220898 '*'0V-f" My Commission Expires COUNTY OF �rocoalr ''41111" January 25, 2028 Sworn to(or affirmed) and subscribed before me of Physical Presence or Online Notarization this'1.1Irday of M"rCk-N , 209A by Q e_VN ':) �4Q C�1 Yl Name of person making statement. Personally Known_�K OR Produced Identification Type of Identification Produced (Signature of Notary Public-State of Florida) Commission No. (Seal) REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev I JAVC 1n1a 11VVV1l0C rVn 1VVrl U%jjA %P%1V 1CC UAI t OF 6EHVIUt SEE BINDING TERMS ON REVERSE M FT. LAUDERDALE ROTO�; - Roto-Rooter Services Company ROOTER Remit to:5672 Collections Center Drive,Chicago IL 60693-0056 yvl a ) 7 4 PLUMBING` For Service Please Call 1-800-GET-ROTO(438-7686) SERVICE TECHNICIAN'S NAME WATER CLEANUP General (954 )418-1461 •FAX(954)418-6971 LaUUMIMA 1 -800-GET-ROT CFC#1428009 - • 7 5NG LZ o r L%AXt4e SEWER&DRAIN❑ PLUMBING PUMPING❑ INDUSTRIAL❑ EXCAVATION❑ DRAIN TILE❑ CUSTOMER NAME CUSTOMER NO. CUSTOMER CLASS vrru RESIDENTIAL ❑ COMMERCIAL BILLING ADDRESS APT.NUMBER FEDERAL I.D.#42-0499300 CITY STATE/PROVINCE ZIP/POSTAL CUSTOMER PHONE NO. P.O.NUMBER/AUTHORIZATION 2/ ILAO'� SERVICE ADDRESS(IF DIFFERENT THAN BILLING ADDRESS) I CITY STATE/PROVINCE ZIP/POSTAL WORK ORDER AUTHORIZATION I authorize the services indicated and agree to pay the amounts specified.I have read and agree to the terms on the reverse side, including the limits on Roto-Rooter' esponsibility specified in those terms.I acknowledge that under paragraph 2(b)of those terms,if Roto-Rooter equipment gets stuck in a pip ,I may be rest) ' for the cost of removing that equipment,including any required excavation. (SIGNATURE) Jae— (PRINT NAME) REPAIR cobE ESTI ATE AND DESCRIPTION OF WORK TO BE PERFORMED(The approximate starting date is and the approximate completion date is .Neither date is guaranteed.Unexpected conditions or problems could cause delays.A definite completion date is not of the essence.) $AMOUNT ADJUSTMENTS/CHANGES IN WORK TO BE PERFORMED(Use additional invoice if needed to describe changes) RESIDENTIAL GUARANTEE COMMERCIAL GUARANTEE PAYMENT LABOR LABOR ❑Main/Branch Lines 6 months ❑Main/Branch Lines 30 days ❑ CASH ❑CHECK NO. LABOR$ CA:> ❑Toilet Auger 7 days ❑Toilet Auger 24 hours CREDIT CARD ❑ NET 10 DAYS LABOR TAX$ ❑Plumbing Repair 6 months ❑Plumbing Repair 90 days OVER 30 DAYS= LATE CHARGE OF 1 1/2% PER MONTH PARTS$ fs'3, Plumbing Replacement 1 year ❑Plumbing Replacement 90 days *In the event check is returned,the CUSTOMER is responsible ❑Extended Guarantee 1 year for all related bank fees. 67*�u 1"n" DISCOUNT$ REASON FOR NO GUARANTEE i PRODUCTS$ COMPLETION I acknowledge pletion of the abovg described work which has been done to my complete satisfaction. SLR OTHER$ (SIGNATURE) TAX$ TOTAL$ 7�o-i2. 33 (PRINT NAME) SUGGESTIONS FOR REPAIR/REPLACEMENT FROM O/S OR TRUCK �/ PARTS USAGE ESTIMATED YOU SAVE CITY T/ TOTAL SELL ITEM LOCATION COST TODAY VENDOR PART# USED OS DESCRIPTION COST PRICE WATER HEATER ` S�laf�✓ DISPOSER SINK TOILET BATHTUB SHOWER FAUCET DRAIN OTHER TOTALS -- (Service Technician's Signature) (CLERK'S SIGNATURE) 191-3 8110 4 OFFICE COPY �I\/_RR-Tf i-2!i!1/i Qll r`� �»d . �.� � •ems >� ''.