HomeMy WebLinkAboutBuilding Permit Application All APPLICA LE /FO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: I Permit Number: NVA, OR
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:
Address:
Legal Description:
Property Tax ID#: 14 of op q • � Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
k `
r4,J ollork,
Additional work to be pertormed under this permit–check all that app y:
/Mechanical _Gas Tank —Gas Piping —Shutters -I/.Windows/Doors
Electric Plumbing `Sprinklers _Generator Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ ,2 CrV• Utilities: —Sewer —Septic Building Height:
Name AW
/ S Name:
Address: fro t Company:
Citg
Y: erState:r Address:
Zip Code: ` rL/ j Fax: City: State:
Phone No. _ ! Zip Code: Fax:
E-Mail: 'llYlGblr� dily
JA Phone No
Fill in fe imple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
Building and Code Regulations Division
BUILDING PERMIT
SUB-CONTRACTOR SUMMARY
will be using the following sub-contractors for the
( om any/Individual Name)
project located at d
(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.
St.Lucie County/
Trade Name of Company/Contractor State of Florida
License Number
r
Electrical (/��L`fl� ui e
Plumbing
HVAC/ Xae r
Mechanical
Roofing
Gas
OFFICE USE ONLY:
PERMTn ISSUE DATE:
NUMBER: ��0 l 9 act r c�
Revised 07/29/2014
PERMIT# ISSUE DATE
PLANNING&DEVELOPMENT SERVICES
Building& Code Compliance Division
COUNTY
BUILDING PERMIT
SUB-CONTRACTOR AGREEMENT
St.Lucie County Contractor Certification Number:
State of Florida Certification Number(if pliicable):
Oyo1A((- have agreed to be the
1'1�-r 6 Ll I
(Company Name/Individual Name)
coo Ph Sub-contractor for
(Type of Trade) (Pri ary Contractor)
-21
For the project located at
(Project Street Address or Property 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 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
Business Name:
Address:
City/State/Zip:
Pho
email:
I ATU P T NAME DA
STATE OF FLORIDA,COUNTY OF Q` o
THE FORE GOING INSTRUMENT WAS SIGNED BEFORE ME THIS DAY OF 20 I�
BY WHO IS PERSONALLY KNOWN OR HAS
PRODUCED OO ' ' T''� AS IDENTIFICATION.
(STAMP)
C�NG iTUREOF NOT PUBLIC PRINT NAME OF NOTARY PUBLIC
SLCPDS:12/16/2013
PERMIT# 1(00 Dap a I ISSUE DATE
PLANNING & DEVELOPMENT SERVICES
Building& Code Compliance Division
------
iCOUNTY
BUILDING PERMIT
SUB-CONTRACTOR AGREEMENT
St.Lucie County Contractor Certification Number:
State of Florida Certification Number(if applicable):
bw(le r have agreed to be the
(Company Name/Individual Name)
Fjcei I c QS Sub-contractor for
(Type of Trade) ( rimary Contractor)
For the project located at . _a�za, Le.(—
(Project Street Address or Property 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 and Zoning Department of St.Lucie County by filing a
Change of Sub-contractor notice.(Form: SLCCDV(No.004-00)
13USWESS QUALIFIER (Name of the Individual shown on the Contractor's License)
NOTARIZED SIGNATURES ARE REQUIRED
Business Name:
Address:
City/stateaip:
Phone: email:
A,c 711
ATURE PtVWT_NAME –D
STATE OF FLORIDA,COUNTY OF
THE FOREGOING INSTRUMENT WAS SIGNED BEFORE ME THIS I C1 DAY OF h 0i20
BY WHO IS PERSONA41,1, KNOWN OR HAS
PnODU D MLOO 'Q AS IDENTIFICATION.
{STAMP)
(—AG AWAF OTAR UBLIC PRINT NAME OF N�OTAWV PUBLIC
SLCPDS:12/16t2013
DESIGN ER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone 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 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.
Sign re of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
V__
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The going ins�cVment was acknowledged before me The forgoing instrument was acknowledged before me
ti IT day of 2014 by this day of 20_ by
Q
(Name oqDerson acknowledging) (Name of person acknowledging)
(Signature of Notary Pubfic-State of Florida (Signature of Notary Public-State of Florida
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
ComrMssion 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
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