HomeMy WebLinkAboutMehan.pl.permitAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 2t Permit Number:
A
• F
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 TYPE: Re'io e �Udy6bl�'i r ( t M IreVtd V"Ec--z8-r,
PROPOSED IMPROVEMENT LOCATION:
Address: 5au g S i I vox- Cci jL Dr
Property Tax ID #: 340 Q --6'-)C(0 --Q (4 Q - 000 l (,5, Lot No. (1- Site Plan Name: Lin s U-Block No. 2-5
Project Name:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION':
Additional work to be performed under this permit -check all that apply:
Mechanical
_ Electric
Gas Tank
/Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ --IS
(-3, oc
_ Gas Piping
_ Sprinklers
_ Shutters
— Generator
Sq. Ft. of First Floor:
Windows/Doors
_ Roof Pitch
Utilities: —Sewer _ Septic Building Height:
OWNER/LESSEE:,
CONTRACTOR:
Name t%I L • 6JAE-ft k1�j
Name:fa�V
Address: �C2 4 S r )vim 6GaC_._ Z- t
Companyj:�;lul, r ifs 110m f9ii-Aq t
City; 5tate:i�� .
Zip Code: 3tl c� Fax:
Phone No.-7-7a- 9 3 13
Address: f 5'57 A-Ja�v1ar � f
City: F00- fit. wck'e State: FL,
Zip Code: 3grl S',_ Fax:
Phone No `1 7a.-"3:3`7- 2.--�.-'2-
E-Mail -I Af_Q 0i +` &d 4 CiDlvm e,*- . &Okkt
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
State or County Licensee i425'(
..,.-_ - .,.,.....,..— - IIIVI O, 0 ncwnuw 1wLMt: yr wmmencemem: is requirea.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
NEER: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITTLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:_
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
_ Not Applicable
State:
Not Applicable
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 paying twice for
improvements to your property. A Notice of Commencement must be recorded in the public records of St.
Lucie County and posted o the jobsite before the first inspection. If ypu intend to obtain financing, consult
with lender or an attorney�efore commencing work or recording voth Notirhe of Commencement.
of Owneesse#Contractor as Agent for Owner i Si ature of
�
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF ST L e_ Cc,V-1& Art COUNTY OF ST Loc-te-- C�-rs t
o (or affirmed) and subscribed before me of
P ysical Pree or Online Notarization
this day of,( (JAE;�E_-7 2020 by
Name of person Makingstakement.
Personally Known •1/ OR Produced Identification
Type of Identification
Produced
(Signature of Notary Public- State of Florida )
Swgrn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this 'W day of 2020 by
md A -A 0'_AV_D 6(/Lf ?,C
Name of person making statement.
Personally Known V OR Produced Identification
Type of Identification
Produced
(Signature of Notary_Polil;- Jtate Qf EIorcla)
Commission No.:"'•':. OLE
Q
— otary Pubii� = ate of Florida
t►+' DIA CO
Commission No. lacy Putrlic f Florida
Commission N GG %10>i4
''•�
Commission N GG 961089
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My Comm. Expires Mar 14 2024
B
d through Nation
I Nda►y Assn.
B
d through National
otary Assn.
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