HomeMy WebLinkAboutBUILDING PERMIT APPLICATION-CHANGE OF CONTRACTORI I
All APPLIOIBLE INFO MUST BE COME '= 'ED FOR APPLICATION TO BE ACCEPTED
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Date ��—
K)cCEIVED
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B ilding PermitApp li
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Planning �nd Development Services
Building and Code Regulation Division
2300 VirLiinia Avenue, Fort Pierce FL 34982
Phone: 772) 462-1553 Fax: (772) 462-1578
FEB —a Z019
ermitting department
St. Lucie County, FL j
Commercial Residential
PERMIT
TYPE:
PROPC7
ED 1NPWVNEW
Address:
Property
Site Plan
Project N
Additio
Total Sq
Cost of I
'3.5 W )0
t e i �v
r '/ to /
FvH- flee q E! L Al2 5)
ID#: &# I�0!^3)1-0015-000^5
me:
11CV
Lot No.
Block No.
C�sC rP S14-b A ./"J%1 V' o /Jd6 A i /Wr
work to be performed under this permit— check all that apply:
hanical _ Gas Tank _ Gas Piping _ Shutters
tric I!j Plumbing _ Sprinklers _ Generator
t of Construction: ' LIOO Sq. Ft. of First Floor:
nstruction: $ 49 3?o a D Utilities: —Sewer —Septic
Name M Ptt,t f- 14Pi if C
Addresl5:V lilt) � cpu l ,�,, Ale
City: _ Fr rP I e%Cti State: 4::�-
Zip Code L 5 Fax:
Phone o. o i 7� �� 4.2 LDS-
E-Mail:`` � �e ue �I b
f L`d �
Fill in e simple Title Holder on next page ( if different
from 4e Owner listed above)
_ Windows/Doors
Roof Pitch
Building Height:
Company:
Address:
City: State:
Zip Code: Fax:
Phone No
E-Mail
State or County License
If value o construction is $2500 or more, a RECORDED Notice of Commencement is required.
If value �f HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLEHOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
Name:
Address:
City: Stater
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 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 your Notice of Commencement.
Signatt�7eofj�Qwne1/Lessee/Contractor as Agent for
T' t
Signature of Contractor/License Holder
STATE OF FLORIDAA.
o
STATE OF FLORIDA
COUNTY OF -
a X` a
COUNTY OF
2 37 i.
The for instru ent was acknowledged before
Ef Pm?cn �
The forgoing instrument was acknowledged before me
,going
this day of 20M. by
;v Z
this day of , 20_ by
31
ai p V
Name of person making statement. I I i6N JJ
Name of person making statement.
Personally Known OR Produced Identificati
Personally Known OR Produced Identification
Type of Id i a 'on ff1i�
Type of Identification
Produced - �`� C
Produced
a Z
(Signature of Not Public- State of Florida)
(Signature of Notary Public- State of Florida )
Commission No. (Seal)
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
.'SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 9/26/18