HomeMy WebLinkAboutNew Building Permit Application ......... Planning&Development Services
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Building& Code Regulations Division
COUNITY 2300 Virginia Ave.
F 0 R I D A Fort Pierce,FL 34982
(772)462-1553 Fax 462-1578
CH�ANG�EO�FCI
Or
Or su or or c=nce=on M pRir�mi
Change of Contractor is to be completed by the property owner, and the new contractor of record for the
current permit. A new permit application must also be completed with new contractor information,
signature, and transfer fee. A new Notice of commencement must be filed in the new contractor's
name for job value's greater than $2,500 ($7,500 if A/C Change-out). A recorded copy must be
submitted prior to commencing any work. Subcontractor changes can be completed by the general
contractor. Any cancellation of permit must be executed by the owner or qualifier of record.
Date: Permit Number:
Site Address: 9 . C ALI&- 'Far-" P1, FL..- 3 1,-/
—State License 9 3 SLC License
Original General Contractor(or Su contractor}
M CA f1eCfF,&tJL -5p';5. State License �ttl3O[SCct,'fSLC License-"Z'-/,7-673
New General Contractor(or Subcontractor)
Reason for Change
The undersigned does hereby agree to indemnify and hold harmless St.Lucie officers,
e County,its ocers,
agents,and employees from all costs,fees,or damages arising from any-and all claims of action for
any reason,which may arise as a result of this change of contractor/subcontractor or cancellation of
permit.
SIGNATURE OWNER (or owner/builder) SIGNATURE OF NEW//GENERAL CONTRACTOR
PRINT NAME
PRINTNAAE _4"4_ )ka/,5k&//
Te
State of Florida,County of St.Lucie County State of Florida;County of St Lucie County
The following instrument was acknowledged before me this The following instrument was acknowledged before me this
.(��dayof 14aa'-60-r- 20_(L-by Avg day Of 2o]5_ QtAAtjw_r-,
Fe-A,,- A who is personally know to me who is personally know to me
or whoas prod ed(A
E hk ;) t�. as ID or who bia produced'F-L I)L- as ID.
((6- 15
signaDate Signature of Nota% , Pate Ruby L.Bright
%Votart'
State of Florida
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vAA1V,1 00
01NN MY COMMISSION#FF 12374
...........
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j40 A,9 * +w- OF rY Ex0ires*:-April 25,2017
ly sigN required for change of subcontractor
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1 Oftember 01,2018
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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED q
Date: N% 5 Permit Number:
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
PROPOSED IMPROVEMENT LOCATION:
Address: �OO K A v2 ` +/n / tI 1r
Legal Description: 1 216 Ll0 l= r3 C S �Ty} IN-4 �>`K C7 t Ve k c�h r. Y�-f chic/ 5 30
P-r o N 3 3 o r+ c, 37-3 -S Fr aF IV Ir'K c�F I� r ISN r�FSF %2C�.Lt /Af)�rl . yys ►`d%9�
Property Tax ID#: 3 c-( C — `l D O C,7,- 000- 0 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
C—) (.�J-vRd APPI I C40`11Z r�)c' w X210cC `O A-f t-'C
Il/l�vLi powbz d2 Sroz� UiPo0z
CONSTRUCTION INFORMATION:
Additional work to be performed under tispermit—check all h appy:
HVAC Gas Tank Gas Piping _Shutters Q Windows/Doors
Electric Plumbing ❑Sprinklers Generator Roof
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ ����•d d Utilities:Sewer E Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name bc^%a.`r\ `N Name: k t 119^61,a/1 x
Address: Company: MA fS1%&/( Clectf•a/A- SOP
City: '�0.IN S O S@ State: ' Address: 1/11, 5*- e QUA c r•//��
Zip Code: �S 3� ax: City:Pbrlr .4 JL '� State: r/•
Phone No. Zip Code: 3 rr q 5'L Fax: 3`9 V' LS w cf
E-Mail: Phone No. 3 70 '3-t^50
Fill in fee si le Title Holder on next page(if different E-Mail: .W i rc. 1W F -713 0 (/hIt-'I . Ca"I
from the Owner listed above) State or County License:
If value of construction is$2500 tgiaf� tftq @f C — � ' _ 49d%• Ruby L.Bright
Subscribed and swo ore me on State of Florida
123 7141P
(No Signature) SOF F`°� Expires:April 25,2017
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 TITLEHOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name: ,_
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 Countv makes no representation that is granting a permit will authorize theermit holder to build the subject structure
which Is in conflict with any applicable Home Owners Association rules,bylaws or andcovenantsthat 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 our Notice of Commencement.
Signature of Owner/Le se A Signa ure of Contraefibr7111cense Holder
STATE OF FLORiDA� STATE-�� FLORIDA r
COUNTY OF COUNTY LAA_6(
The forgoing instrument was acknowledged before me The forg�pg instrument was acknowledged before me
this day of Alf t&— ,&r . 20 Jby this day of fMOt,, PV .20•l�by
Et Q_� X I '�:Iln 2::1 A sl�eyt_ Vav (%AIR LIA
Name of pers ncitnowl dging) (Name of person clmowledging)
l �
0,
(Signature of NoldyPublic-State of Florida) lgnature of Notary Pu -State of Florida)
Personally Known OR Pro ce I FEation Personally Known-N tification
Type of Identification Produced Type of identification Prod d nn a 4,2.tF a %
Olt PrjA pfl
Gg UL
Commission No. (Seal) Cor# *o.l= of RO� aa1)
. .
Revised 07/15/2014 Commission No. FF 908306
' AN ELA M HUFF
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REVIE ,Sri. EftMiry Pu I190811INg Florl a PERVISOk PLANS VEGETATION SEATURTLE MANGROVE
•• ffe timis I �F�@ft4T3o EVIEW REVIEW REVIEW REVIEW REVIEW
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DATE �I� ; •' y omm. xp res May 27,20 8 '
COMP Bandedthrou National Notary As .
INITIALS