HomeMy WebLinkAboutBUILDING PERMIT APPLICATION CHANGE OF CONTRACTOR 1-30-17`K111WA -� I
All APPLICABLE INFO MUST BE COMPL'ci Eb FOR APPLICATION TO BE ACCEPTED
Dat GJ' 1 Permit Number: L0,5101 0c7
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Plan ing and Development Services
Bulk ing and Code Regulation Division
230 � Virginia Avenue, Fort Pierce FL 34982 (CANNED
BY
Pho e: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
IP
PE
!MIT APPLICATION FOR:
PRC�}' ®SED I'N�PR®\/E�MENT LQC TI'ON:
Address:
Legal
D escription:
Property Tax ID #: ' 12 % -W/ 2. —6y 2 Lot No.
Site P an Name: Block No.
Proje ;it Name:
Setb I ks Front Back: Right Side: Left Side:
I!; In A ;�
TRU'C 120' INI= �' + 00
PRIonal
work to be pertormed under this permit —check all t at,app: y:
ech6nical _Gras Tank _� Gas Piping Shutters _ Windows/Doors
lectric _ Plumbing _ Sprinklers _- ,-._'Generator _Roof Pitch
Total j Iq. Ft of Cori'struction: ' Sq. Ft. of First Floor:.
Cost 1 Construction: $ C ? Utilities: _ Sewer _ Septic Building Height:
1S1SEE:
CONTRACTOR:
,Na e Fj gw4 S hafieS
Name:,1_ •
Add ess F' ��L�lf'S��J
'r"r���r� 'J� �
Company: c-
d r;rYi laa
Address:
City:
r,
,�,Srt�a+,te:
Zip ode: f�iLjQr �-- Fax: �d72• �i0V%4o0
City: �_1109 �.. State:(FL_
Phorti'e No;0 72- � � �
Zip Code:t3.YW't 1 Fax:
E-M il: 4WAq95M I+x4 iK- I n '
Phone No
Fill i fee simple Title Holder on next page ( if different
E-Mail_
fro the Owner listed above)
State or County License V0
If valu i of construction is 2500 or more, a RECORDED Notice of Commencement is required.
SUP'P EMONTAL CONSTR ON LIEN LAW INF®RMATt®
DESIGNER ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
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,'coV;en.ants.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 hoh-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
commpncinE work or recordine vour Notice of Commencement.
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177
i1g. tureo� f6inrnei%Lessee/Contractor as-dgerif�fl
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Si _ turesofaConractoY/License Ho_ Ider
S TE OF FLORFD -
y
S TE OF FLORIDA
�
COUNTY OF
" m.
COUNTY OF
�i
The forgoing instr ent was acknowledged before
this day of 20Z by
¢ z
a W
The forgoing ins ent was acknowledged before
th,is� day o%' 20�Z byca
IJJ U L
UX a
�w
N.
Name of person ackn wledging)
=o..=
(Name of person ackn wledging)
(Signature of tary Public- State of Florid )
(' nature of N • ry Public- • State of Flor a )
Identification
Personally Known / OR Produced Identification
Personally Known OR Produced
Type of Identification
Type of Identification
Produced
Produced.
Commission No. (Seal)
Commission No. . 4. (Seal),
REVIEWS
FRONT
ZONING _, . .,.-SUPERVISOR
PLANS
VEGETATION
SEA TURTLE'`
MANGROVE
COUNTER
REVIEW
• REVIEW
REVIEW
REVIEW--
REVIEW .:..:
REVIEW
DATE
RECEIVED
-DATE
COMPLETED
ev. 7/2014