HomeMy WebLinkAboutPalino Permit App(shed)All APPLICABLE NFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: -1jPermit Number:
A(J)
' �Oatm " - Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34992
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: '' G' �T� P VU JCS." I- r i-4 C , i- i - J -r 7 `I
Property Tax lD #:
Site Plan fame: Project Name: �)a1ll
m 0 &_;G
5
Lot No.
Block No. n
I DETAILED DESCRIPTION OF WORK: I
Dr SIwi 011_1 t C rzv- u
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 Plumbing Sprinklers
Total Sq. Ft of Construction:'
Generator V Roof Pitch
Sq. Ft. of First Floor:
Cost of Construction: $ ID Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE.'
CONTRACTOR:
Name ft)anaoti}ate
Name: 1�
Company:
Addre
Address: Ci"T 1j !�
City: P1ccl Stater
Zip Code: �L/Clq 5� Fax:
City: VL 4 -C,,Jf ` iCI'�'
State: 7
Phone No.�'�l' 7`-9
Zip Code: —�7J2 Fax:
rr��
�C�
F-Mai1: //,J/x?.//1-il 'j 611 110rh/aL-Al c�S:i
Phone No-1-121, ZP2-
Fill in fee simple Title Holder on next page ( if different
E-Mail OAI' ice, C.y-�►�5��
� . _ � �'7
State or County License / 00-?_
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.
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 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.
5t. 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 con currency 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 an the jobsite before the first inspection. If you intend to obtain financing, consult
with len-der or an attornev before commencine work or recording vour Notice of Commencement.
of Owner/ Lessee/Contractor as Agent for Owner jai ature of
Holder
STATE OF FLORIDA i - ` STATE OF FLORIDA
COUNTY OF � o COUNTY OF G+ �u C_i.
Sworn to (or affirmed) and sun cribed before me of
Ph sical Prese c or Online Notarization
this 'd of 2020 by
>�IClIL=�
Name of persoh makings . ement.
Personally Known OR Produced Identification
Type of Identification
Produc • Lj ?' D
(Signature of Notary Pubiic,�tate of Florida )
Commission No. - ■ (Seal)
REVI EWS
REVI
DATE
RECUVE❑
DATE
COMPLETED
5to (or affirmed) and subscribed before me of
PPhysica€ Prese ce or Online Notarization
this ay of rJ 2020 bycmu-I'VA r�OvDea'
Name of person mak7OR
ment.
Personally Known Produced Identification
Type of Identification
(Signature of Notary Public- Stfe of Florida )
Commission No. (Seal)
PLANS 1 REVIEW I V � V E � � _ EQ11WVE