HomeMy WebLinkAboutSUBMITTED PAPERSALL APPLICABLE INFO M ST BE t UMPLETED FOR APPLICATION TO BE ACCENi cb
- I
Date: — Permit Number: 1410--a-sv)
SCANNED
BY
St. Lucie Count
Building Permit Count
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 X
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: 7 ° is /�,�/�� C' j�2. /mil aY,9d1:6
Legal Description:
Property Tax ID #: 3 3 ZZ 3 —Owa — Z Lot No. z Z
Site Plan Name: N/14 Block No. 366'
Project Name:
Setbacks Front Back:
DETAILED DESCRIPTION OF WORK:
Right Side: Left Side:
CONSTRUCTION INFORMATION: INFORMATION:
Additional work to e nertormed under this permit —check a apply:
11HVAC1:1 Gas Tank ❑Gas Piping _ Shutters Q Windows/Doors
51 Electric Plumbing Sprinklers E Generator 0 Roof
Total Sq. Ft of Construction: S . Ft. of First Floor:
Cost of Construction: $ �� /9// Utilities:Sewer []Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name /2.
Name: AC/Ey'a4oIV ��4�>�iG�-✓
Company:
Address: '70� (o�y `i✓'iC-J c��t-
City: Stater -:
Zip Code: 7,V10J_& Fax: /✓/,*
Phone No.
Address: S--D 7.1'r-1�/t_
City: /0'(1_ State: P:::�_
Zip Code: �i'°��o' Fax: F7e 0J7o Z
Phone No. .0/-3J-13
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the the Owner listed above)
E-Mail: S��iO£�NL— �9�E�i ►��r
6te)r County License:
it value of construction is 52500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMP Y: _ Not Applicable
Name: All-1-
Address:
Address:
City: State:
City:
State:
Zip: Phone:
Zip:
Phone:
FEE SIMPLE TITLE HOLDER, _ Not Applicable
Name:
BONDING COMPANY:
Name:
Not Applicable
Address:
Address:
Address:
City:
City:
Zip:
Phone:
Zip: Phone:
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 vour Notice of Commencement.
Signature of Owner/ Agent/ Lessee
STATE OF FLORIDA
COUNTY OF 5c.�.n4- �c:2
The forgoing instrument was acknowledged before me
this ` day of 20 14 by
Signa ure of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF
The for oing instrument as acknowledged before me
this day of 20_1A by
1 1 I` i % aA &46 L (YAP{ ,o
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public- State of Florida )
Personally Known _
Type of Identification
Commission No.
Revised 07/15/2014
OR Produced Identification
WAUACELTWJN
�>l19M#�/D01�196
&&O-pe wa3or)
(Signature of Notary Public- tate of Florida )
Personally Known OR Produced Identification
Type of Identification Produced
Commission No F MUM
UM
BARBARA WAT�
MY COMMISSION #FF
EXPIRES August 28,
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
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FPE RMIT## 14 1 0- %13LDLI ISSUE DATE
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT
St. Lucia County Contractor Certiiicadon Number:
State ofFlorida Certifications Number (Wvpucabtop
"' ,e3= ccr �`C M, c,(, ^� ct�, have agreed to be the
Co N+ ane/Individual Name)
l 2 <► C Sub -contractor for SQL M--c D f, X 6-e ce Zry_ ,
(Type ofTradc) �1 (Primary Contractor)
For the project located at 1 ���,p Tip i-%CLJ R ans (a (-
(Prvlcvt Street Addresa or Propap*Tax ID #)
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 anal Zoning Department of St. Lucie County by filing rt
Change of Sub -contractor notice. (Form: SLCCDV (No. 00400)
BUSINESS QUALIFIER IName ofthe Individual shown on the Contractor's License)
NOTARIZED SIGNATURES AIM REQU
f' _ _ . r ^
Business Namr.
Addrfts:
City/stateMp:
�r'-,-'— CtjL "
Phone: & amait: L •7e f
SI NA . 1£ P T NAME DATE
STATE OF FLORIDA, COUNTY OF 14
THE FOREGOING INSTRUMENT WAS SIGNED BEFORE ME THIS DAY OF W//
BY _ W, cfd rig WHO IS PERSONALLY KNOWN OR KA8
AS IDENTIFICATION.
..A A_ I
(STAMP)
.TUBE OF NOTA14Y PUBLIC PRINT NAME OF NOTARY PUBLIC
12/16R013 v
=Publicic State of FloridaPaulasion EE0660217/2015
i /Z -aovd 7607LLLZLL .OUT- ' any aaS yV Oz:TT 17TOZ'6Z'g00
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PLANMG & DUELOPM", SMMIS
lInU ing & Cade Compftow Division
8UlW0NTftCWft,&Mzzra+ FM
ft tame Cou* Contractor CsRM=ftn Nuenbr,
Stnre otFio i& GadScaSo n Number araAFlic"t
Gr�es:t �
have speed to W *e
YLu� �1R6 Sub-rvniractor forSee--- i F #� i:rr—
CPAx oiMude) r (hi mry Contractor)
For the g oied located at 1 U Ir • f l
M*jact Stw Addrm or Tic M 6)
it is anderstaad beat, tf there u any rMU$e of states r08=JKag our PM*oijI* ion wilt the above tr►entiottte4
n� IA nnmd*t advie tie Ulding*Zo*g Dega bnt of StLude Cou* by filirt$
Change of Sub-c mractor notice. (Form: SLCCDY (No. M-oo)
BiTMMM QUALMIR (Name of the [ndMdad sho m on the Comtaalnes Ucensc)
NOTARIZED SIGNATURES ARE REQUIRED
Bu�neaaNttrne: ts�-P-s2QS `S l4Gu�.,.,d��+ S�-NiGe.s Side, .
� f 9S� Ste!' /3o f .. �✓�
e G 3 `t
Phone: —/,&2 3 3 7 3 6 8a await: 4 enes,r s
t3iGNA RE �— PRINT NAME DAT&
STATE OF FLOR10k COUM OF . L -1
THE FOREGOUVG IlYSTRUM LWT WAS SIGNED BE FORK ME, TWS DAY 0 Ltf
BY MAI WHO N PUMNALLY RNOWN OS BAS
PRODUCE) -- -__ AS IAICNTIFICARON.
M D
LffaA.TURE OF NOTA"RYP OB
SL.CPDS: 1246AD13
hdm,cn li)2� (sTAIe)
PRINTMAMEOF OrARY ru
K
�+o;;a�o�;4�.•
"t ,':j
BARBARA WATSON
MY COMMISSION 4VFF155600
ao,;,d�
EXPIRES August 28, 2018
(407) 398.0153
FloridafttaryService,com
JOSEPH E. SMITH, CLERK OF THE CIRCUIT COURT - SAINT LUCIE COUNTY
FILE # 4011982 OR BOOK 36 - PAGE 2145, Recorded 11/10/2014 at 0;- AM
AFM RECORDING - RETURN TO:
PERMrr NUMBER: 14 IV-O l.V 1
The undersigned hereby gives notice that improvement will be made to certain real property, and in accordance with Chapter 713,
Florida Statutes, the following information is provided in this Notice of Commencement.
1. DEscRIPriON OF PROPERTY(Legal description ofibe ptoMty&sued address, ifavailable) TAX FOLIO NO.: dCf'JU�^OW�WO�t�
SUBDIVISION BLOCK-cl cr LDt. 12@ BLDG UNfr
y. GENERAL DE,SL'RIMON OF IMPROVEI Off:
3. OWNER INFORMATION \ORR LESSEE INFORMATION IFTHE LESSEE CONTRACTED FOR THE IMPROOVEMENT:
• IC. Wn 10-11n
a Nameed address 1•t1 i ac--nrsh
b. Interest in property:
e Name and address off ample tideholda(ifdiReen fiorn Owrartia e):
4. a. CONTRACTOWSSNNAAMME]:,, 1
,/1
camaaa'sadaea3: �J Z�� - I)� _�-
b.Phonenomba:.—
5. SUREIY(ifawlimble. a Dopy ofthe peymee bond is anarhad):
a Namesnd addreu:
b. Phone mamba: _
6. a. LENDER'S NAME,
Amunt ofbond:
l.mddsaddress: b.Phme mamba:
7. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provided by
Section 713.13 (1) (a) 7., Florida Statutes: .
a Nsmeandsft=
8. a. In addition to himself or herself, Owner designates of
to receive a copy of the Lienor's Notice as provided in Section 713.13 (1) (b), Florida Statutes.
b. Phone numba ofp—n or amity daDmd by Ovma:
9. Expiration date of notice of commencement (the expiration date will be I year from the date of recording unless a different date is
specified): . 20
(Signature ofOwner or lessee, or Owner's or L
Authorized OfficerMireetor/PartnedManager)
State of
CGamy of n} L- C.
(Print Name and ProvideSigoatory's 'fide/Office)
The foregoing instrument was acknowledged before me this 29*� day of C lObes' . 2.0 ILI
by 'Ic. t`lelJ�V) tL--Vn i4%
.. as t7tki r,-e,— - - -
(name ofperson)
(type ofautlrarity,...e.gofficer, trustee, attorney in fact)
for
(name of party on behalf of whom instrument was executed)
Personally Known _ or Produced identification 'Z
Type of Identification Produced 'F t_
WRL4Mr.N%e-iu..i--
}/j��Vt WC0LQffigM#FF0l9988
(Signature of Notary Public)
WRES:AUG04, ffif7
BandW Ww h Istshta Insurms
(Print, Type, or Stamp Commissioned Name of Notary Public)
Rev. Ice-15-I2
STATE OF FLORIDA
ST. LUCIE COUNTY
THI TO CERTIFY THAT THISS A
TR4F 4ND CORRECT COPY 0
ORI I L.
Date:
PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
Building and Code Regulations Division
BUILDING PERMIT
SUB -CONTRACTOR SUMMARY
5�7sv;e- ,& � C�/LE'-./✓G �+�Q/C, will be using the following sub -contractors for the
(Company/Individual Name) ,p
project located at ?d ��� �/�L:i e/2 /"��- 2 Y,9d6
(Street address 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
�� �i t Z C-�✓ Lz��✓���
Plumbing
is
HVAC/
A11A
Mechanical
Roofing
Gas
OFFICE USE ONLY:;
PERMIT ISSUE DATE:
NUMBER:
Revised 07/29/2014