HomeMy WebLinkAboutHWH PERMITAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date
Permit Number:
IIr
Building pp 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:
PROVEMENT LOCATIO
Address
Property Tax ID #: -33 –'sol –o) --?),I
Site Plan Name:( U'A(A"" ti i citt V
Project Name: mC' V_'i,` 1 P5 fj
DETAILED DESCRIPTION OF WORK:
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Lot No.
Block No.
Additional work to be performed under this permit– check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors _ Pond
_ Electric J Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ j7y Utilities: —Sewer _ Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name C% ^' -4 (9 Q'2-1 Li_
Address: P I
City: ?02k,1_, � , Stater
Zip Code: c{–' 1� Fax:
Name: _'ck- or
Company:
Address:S
QA
City: 'k�A JjLtLK \\ Stater
Phone No. 7:201Z 2_7.>
Zip Code: Fax:
PhoneNo
E -Mail:
Fill in fee simple Title Holder on next page (if different
E -Mail ��.t (` jC.i5tY1;�--ill- •!✓�
from the Owner listed above)
State or County License
IT value or 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.
DESIGNER/ENGINEER:
_ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City:
State: City: State:
Zip: Phone
Zip: Ph e:
FEE SIMPLE TITLE HOLDER:
_ Not Applicable BONDING COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: Phon
Zip: P one:
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 id 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 Commence"ret may result in paying twice for
improvements to your property. A Notice of Commencement mtist be record in the public records of St.
Lucie County and posted on the jobsite before the first inspection. If you intond to obtain financing, consult
with lender or an attornev before commencing work or recording vour Notre of Commencement.
Rev. 3/ o/ cu
Signature of Contractor/license Holder
a ure of Owner/ Lessee/Contractor as (agent for Owner
i
'STATE
STATE OF FLORID a"
COUNTY OF_ �L�,� �;LC�i h
OF FLORID
COUNTY OF raft'" t�Qlill,�'1
Sworn to (or affir ed) and subscribed before me of
SworpAo (or affirmed) and subscribed before me of
sical Pr nce or Online Notarization
✓ P ysical Presence or Online Notarization
—
this day of 2020 by
this � day of 2020 by
7TI)� P5
J
L lrxn %Q--., �O�
Name of person making statement.
Name of person making/statement.
;Z
Personally Known OR Produced Identification
Personally Known V OR Produced Identification
Type of Identifica
Type of Identification
Produced
Produced
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Notary Public State y�i�lgrida
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My Commission Expires
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%+My Commission Expires
10110 JuIv 25, 2023
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REVIEWS
SUPERVISOR
PLANS
VEGETATION
MANGROVE
FRONT ZONING
SEA TURTLE
COUNTER REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 3/ o/ cu
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