HomeMy WebLinkAboutSUBMITTED PAPERSALL APPLICA/B-L INFO UST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �"�'
Date: l(/ Z`I IS SCANNED Permit Number: (v!✓�
BY
� AM
-0101 "`� St. Lucie County
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
Address: 3y(V5 DA'IC
Legal Description:
Property Tax I D #:
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
Lot No.
Block No.
7cwr�o iws . KLbvw
x � o reCT �iaCt(�-V--rLw-) . LAC Ck C� ASSocuiT,
❑HVAC UGas Tank Gas Piping UShutters ❑ Windows/Doors
Electric 0 Plumbing ❑Sprinklers Generator Roof
Total Sq. Ft of Construction: Z309 S Ft. of First Floor:
Cost of Construction: $ ���. Utilities:Sewer OSeptic Building Height: �71 aYL2
0111%NER/LESSEE^
, may.
CONTRACTOR
a
Name ZS iz t _ L.L-c.
Name: 7�0Cif Z CeM%?X,;'3G
Address:205-�
Company: i
_C,,"AS-Sly
City: _'TTStiLCF, State:'Et_
Zip Code: � i 0Z Fax:
Phone No. ��Z—�(op—�t3�
Address: /5� 1
City: i zC.E State:=�L
Zip Code: Fax:
Phone No.
E-Mail: OL.z4'1(• At 00 &LaAgo. C'J�
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail:
State or County License: Z %Aa
it vame or consirucaon is $Abuu or more, a RECOROEo Notice of Commencement is required.
vc awr. onJ&rr ar r.or n: = UMM Hppncaole MORTGAGE COMPANY: _v"' Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone: 11
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
City:
Zip: Phone:
Applicable
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY:
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 ins ection//If yo nd to obtain financing, consult with lender p� an attorney before
commencing vy�r reGbrdi I'll Notice of Commencement. i . r /) .
Lessee/Agent
re
STATE OF FLORID,, r STATE OF FLORIDA
COUNTY OF /• ✓Cbe COUNTYOF Sr. LuGic
The flQrgP ing instrum nt was acknowledged hefore me
this,Zfday of ;i 201_ 1 by
�6 z A
1
(Name of persona nowledging )
(Signature of Notary Public- State of Florida )
Personally Known OR
Type of Identification Producec
tI Coy Publmissio # ateFF o1
Commission No. O al)Cammissloni1FF20
My comm. expires Mar.
Revised 07/15/2014
The f�olrgoing mstrumee t was acknowledged before me
this Z %day of J V01 I 20 If by
CO %a #a.
(Name of person cknowledging)
//—/--4�_
(Signatu a of Notary Public- State of Florida )
of
Known OR
[7
MY Comm. expires Mar.
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
INITIALS
r
REVIEWED FOR CO,r1P
REVIEWED DATE BY r a
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PLANS AND PERM BE -KEPT ON JOB
OR NO INSPECTION WELL BE MADE.
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THESE PLANS AND ALL PROOOSED WQIRK , }`�
ARE SUBJECT TO ANY CORRECTIONS t
REQUIRED BY FIELD INSPECTORS THAT
---MAYBE NECESSARY IN OR
CA®9EF TO
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CONCEALED FASTENERS OR ATTACHMENTS
ARE THE 0 OF
CONTRACTORSOF RECORD HE FILE COPY
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FILE COPS
JOSEPH E. SMITH, CLERK OF THE. CIRCUIT COURT — SAINT LUCIE COUNTY
FILE N 4089512 OR BOOK PAGE 2601, Recorded 07/09/2015 at 0 AM
I
NOTICE OF COMMENCEMENT —J
The uudcWgmd hereby givem mum that inaPeAemeot wig he made m attain teal papery, and in acuNanm with C mpW713,
Flo ids stalmes thefallowing informmlm isprovided in the NoumofmmmanceneoL
LDFSCRIFftONOFPROPEKff(Iega&smpummdmeetadda)TA%FOLIONUMZFB
3.OWNER
d. Name and addassof fee simple udebolder(dolherthan
4. CONTRACTOR'S NAME. ADDRESS AND PHONE N
5. SUHRTY'S NAME, ADDRESS AND PHONE NUMBER AND BOND A d()NT:—_A(/A
6.LENDER'S NAME, ADDRESS AND PHONE NUMBER: 11r
7. Persons within the Stme of Flaidadesigmid by Owner upon wire, aoum orother documents may be served as pmvW d by
Section 713.13 (1 Xa) 7., Florida Statutes:
NAME, ADDRESS AND PHONE NUMBEFU
8. m addition to bimselforhermlf, Owner designates the following to receive a copy of the Limes Notice as provided in Section
713.13 (1)(b), Florida StetuDw:
NAME, ADDRESS AND PRONE NUMBER:
9. Expirsd(m dare Ofnotice ofcommanmmant(the expiation dare is 1 year from the data of=onfing uolu adiffermtdate is
aped&d) 7B
Owner's Authorized O®adDhcAodParfnedMaosm
Sate of Florida
Cmntyof .S%LJGiL
dAc._ Ot)h3fYL
Print Name sad Parlde Sigmatory'sTitk/OQae
G
(Type ofanthority...e.g. Owm, ofSm, trmtee,
L MLV
roc
(Name ofpartymbebalfofwhominstmmeetware/xemaW) Personally Kmwit orrproduced the following type ofm:r`O�
` /A XPAYBd.ItBPMmol
K Notuy Pt4Yw 8hndHaNa
(Pdow'. ofNo4ry bl) (Si Oanmdealolis FFaB89{
gnemrtoFNorery Pubec) ) R)tmmupbnYE.E5,2919
Un lerpenaluas of perjury, I declare that I have read the foregoing aid that the facts in it an, tone m the beat of my imowlo c and
belief (section 95, Florida e)).
oer(O'Aatherhad OmlDi76g,
eeahodgiedabove:
By. 2a
x.asmoom
STATE OF FLORIDA
ST. LUCIE COUNTY
THIS IS TO CERTIFY THAT THIS IS A
TRUE AND CORRECT qQPY OF THE
ORIGIN
H E. SMIT
Do uty efk
Date:
JUG 0 9 2015
PLANNING & I
Building &
St. Lucie County Contractor Certification Number: 17642
LOPMENT SERVICES
Compliance Division
State of Florida Certification Number (If applicable). EC0001963
RICHMOND ELECTRIC INC. have agreed to be the
(Company Name/individual Name) % � �
ELECTRICAL Sub -contractor for _S0(19`/� Lp,2 yip l Vkty� �-"aroT�A Gzl 't
(Type o£Trade) ` (Primary Contractor)
For the project located at 3965 OAK HAMMOCK LANE, FORT PIERCE
(Project Street Address or Property Tax ID 4).
It is understood that, if there is any change of.status regarding our participation with the•above mentioned
project, Iwill immediately advise the Building and Zoning Department of St, Lucie County by filing;a
Change of$ub-contractor notice. (Form: SLCCDV (No. 004=00)
BUSINESS QUALIFIER (Name of the Individual shown on the Contractor's License)
NOTARIZED SICNATURESARE REQUIRED
Business Name:
Address:
City/State/Zip:
Phone:
Ci �`y'' //�'t.,---� _C��c'sS Y o tah e r 1ti1 i�. t H r, o „G� �o • Z 6 '� f S
SIGNATURE PRINT NAME DATE
STATE OF FLORIDA, COUNTY OF. ST LU,C I E
THE FOREGOING INSTRUMENT WAS SIGNED BEFORE ME Till S 26TH DAY OF JUNE 2015
BY CHRISTOPHER W. RICHMOND WHO IS PERSONALLY KNOWN OR HAS
PRODUCED AS IDENTIFICATION.
Gal _l cx s e V j -IL-is (STAMP)
SIGNAA - RE OF NOTARY PUBLIC PRINT NAMEOF NOTARY PUBLIC
SLCPDS: 08/06/2014
N, CASEY BINKLEY
161Y COMMISSION 0 FF238733:
EXPIRES Aupus116,pi
PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
Building and Code Regulations Division
BUDDING PERMIT
SUB -CONTRACTOR SUMMARY
LKuc�yA will be using the following sub -contractors for the
(Company/Individual Name) _ 1
project located at
or Property Tax ID #)
It is understood that if there is any change of status regarding the participation of any of the sub -contractors
listed below, I will immediately advise the Building and Zoning Department of St. Lucie County.
Trade
Name of Company/Contractor
St. Lucie County/
State of Florida
License Number
Electrical
t, 0b
Plumbing
t } O C t P �w. vv
'�' Qc/ 5 r44 9
HVAC/
Mechanical
Roofing
Gas
PERMIT
ISSUE DATE:
NUMBER:
Revised 07/29/2014
-:;. PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT
St. Lucie County Contractor Certification Number:
State of Florida Certification Number (if applicable): OFCoe; pe&L
For the project located at
Urv)J2�l rJ 6_) / - have agreed to be the
Name)
Sub -contractor for 56U j3-1 EOL4/--.4 LA , Ckp A, Zf KK,
(Primary Contractor)
Street Address or Property Tax ID #)
=-F=orz;rPNZc�
It is understood that, if there is any change of status regarding our participation with the above mentioned
project, I will immediately advise the Building and Zoning Department of St. Lucie County by filing a
Change of Sub -contractor notice. (Form: SLCCDV (No. 004-00)
BUSINESS QUALIFIER (Name of the Individual shown on the Contractor's License)
NOTARIZED SIGNATURES ARE REQUIRED
, 1 o Business Name: f _sm j -e-4- L FLU M/:t >) (-I t5; , 1 f,�C .
Address: G11VJ ESCer9 N-fl (� F'L_19(7�
City/State/Zip: SI . LV, t-E7 r F-L sqcigto
Phone: '772-87S-(p0,Zrj email:
(EilN1FtI L :
zt- Sib VNZ g-j+z6(S
SIGN PRINT NAME DATE
STATE OF FLORIDA, COUNTY OF Si • 1_,1C1EE
THE FOREGOING INSTRUMENT WAS SIGNED BEFORE ME THIS I &bAY OF /k1J61U5T- 20�
BY �[OI,I STb V uL. WHO IS PERSONALLY KNOWN>_ OR HAS
PRODUCED
AS IDENTIFICATION.
I' I (C-I j� S(Ci M GN (STAMP)
PRINT NAME OF NOTARY PUBLIC
MICHELLE D, SIGMON
* * MY COMMISSION t FF 0638D1
EXPIRES: Wober 16,2017
erw�P' B0eded7hra8ad2elN0t2rySenkes
PERMIT II�� _� ISSUE DATE
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance (Division
BUILDING PE%NIIT
SUB -CONTRACTOR AGREEMENT
St. Lucie County Contractor Certification Number: State of Florida Certification Number tlrappli oblo} CX C
have agreed to be the
Sub -contractor for !> �i ; -w- gzx 4 LA -A, ct vc
For the project located
It is understood that, if there is any change of status regarding our participation iN ith the above mentioned
project, I will immediately advise the Building and Zoning Department of St. Lucie County by filing a
Change of Sub -contractor notice. (Form: SLCCDY (No. 004-00)
BUSINESS QUALIFIER (Name of the Individual shown on the Contractor's License)
NOTARIZED SIGNATURES ARE RFQI'IRED
Business Name: (SL -<- /Y/.G 6 ,1,1-1-1T�n
Address: yi Jai. BTo S/
CitylStateitip: 3rl�S 2
Phone: 7%33730o2-c% email ✓ot�y'Gi>'c0t�"'�' "`
SIGNATURE PRINT NAME DATE
STATE OF FLORIDA, COUNTY OF K -1) Q
THE FOREGOING INSTRUMENT WAS SIGNED BEFORE ME THIS 1 D.. DAY O 2015
BY �K s!.-iCA66nc)c�. N'HOISPERSONALLY? IVN OR HAS
PR gUCED CJ q A 1 1 l l' % AS IDENTIFICATION.
L.IJn ,. r.- aV f�l Cg7 c n n {STAMP)
PUBLICC PRINT NAME OF NOTARY PUBLIC
AWLtiMMIit
MY000SVONIFF13M
*
EXPIRES: June 25, 2018
^°h.,W
BoMtdtAtu Bud0N*r/SM1C"
OFFICE USE ONLY: I I C
DATE FILED: 1 C�? V
REVISION FEE:
1.
2.
3.
4.
LOCATION/SITE
ADDRESS:i
PERMIT # - d5 110
RECEIPT #
MENT SERVICES:
MATION DIVISION
AVENUE
.34982-5652
(772)462-1578
APPLICATION FOR BUILDING PERMIT REVISIONS
PROJECT INFORMATION
DETAILED DESCRIPTION OF PROJECT
REVISIONS:
+A74
CONTRACTOR INFORMATION:
STATE of FL REG./CERT. #: U*%Q.
BUSINESS NAME: .
QUALIFIERS NAME:
ADDRESS: 1S-7 o I -
CITY:
PHONE (DAYTIME): 712 -1
OWNER/BUILDER INFORMATION:
NAME:
ADDRESS:
CITY:
PHONE:
5. ARCHITECT/ENGINEER INFORMATION:
NAME: _
ADDRESS: _
CITY: _
PHONE (DAYTIME):
Revised 07/2=014
ST
STATE:
FAX:
P1
COUNTY CERT. #:
FAX:
ZIP:
ZIP:
OR ATTACHMENT$
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