HomeMy WebLinkAboutpermit.HahnAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:'I/ 2D 2-O Permit Number:
O
•. ..' ® -
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: C/25 (DI)e_ Puff farl- 5�. LctGrt�-- , rL 3 V
Property Tax ID #: 333L 5-0 - 0/2-/ 000 -7 Lot No.
Site Plan Name: A-7- Pe-4 Block No.
Project Name:
DETAILED DESCRIPTION OF WORK: I
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit- check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors _ Pond
_ Electric ZlPlumbing _ Sprinklers _ Generator — Roof Pitch
Total Sq. Ft of Construction: Cost of Construction: $ 3 11, 0 c
Sq. Ft. of First Floor:
Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name j3-)2.1 -�/ /-J-.4A/A/
Address: L)2� age Paff /mil.-
Name: ii'gi r—li �
Company: i A/Ud Me- f 10Mhe4> �-
City: al- - 5+ LUC-fe, State: FL
Zip Code: 3L/9&(0 Fax:
Address: /S3 7 5E f5QLA
City: i f Sf baCce State: I-L-
Phone No. 561- Q5 1- (G,Q
Zip Code: 3 `OQ Fax:
E-Mail:
Phone No ~ 79 `3:a-7- 32.2-2-
Fill in fee simple Title Holder on next page (if different
E-Mail i /1-ro <0 /ri alc� T hit;PkIv9&"-`: 6a�
State or County License CFC / q31
from the Owner listed above)
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
Name:
Address:
City: State'
Zip: Phone
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: Not Applicable
Name: —'
Address:
City: State:
ZIP' Phone:
BONDING COMPANY: _Not Applicable
Name:
Address:
City:
Zip' Phone:
OWNER/ CONTRACTOR AFFIDVIT.' Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that noworkor installation has commenced prior to the issuance of a permit.
which is in conWi tawith anrepresentation ithat
e Owners tAsssociation ru es authorizelr and permit
nanits that build
drestrictbor prohibit such
structure. Please consult with your Horne 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 on tthey* bsite before the first inspection. if you end to obtain financing, consult
or aan attorney bfa a commencing work or recording N2,
e of cotrrsxRF,r a.Y,n..+
of Owner/ Lessee ntractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF 'a—v
Sworn to (or affirmed) and subscribed before me of
V Physical PreseJ�ce or Online Notarization
this 20 day of _�1, ri y 2020 by
Name of person making statement.
Personally Known ✓ OR Produced identification
Type of Identification
Produced
(signature of Notary Pu
►" "+ ---dIANE COLE
Commission No. '$ Nota b�j4 State of Florida
Caidn # GG 961089
My Comm. Expires Mar 14, 2024
REVIEWS FRONT ZONING SUPERVISOR
COUNTER REVIEW REVIEW
SAT-- E
DA
STATE OF FLORIDA
COUNTY OF S _T v t
Sworn to (or affirmed) and subscribed before me of
Physical Preser)ce r Online Notarization
this W day Of �tT_ 2020 by
Name of person making statement. —�
Personally Known OR Produced Identification
Type of Identification
siggnature of Notary Public- 5tate of D ... DUNE COL
'- Notary Public - Stat o lorida
Commission No. Commission k GG 89
BMY Comm. Expires Akk r , 2024
onded through National of Assn.
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