HomeMy WebLinkAboutMoreland Permit AppAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
�Ir
Com® Imo.;.
'g Building Permit Application
Planning and Development Services `v
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:C4
PROPOSED IMPROVEMENT LOCATION: l
Address:
a
Property Tax ID #: _� aC` I h LOC - (ADen , Lot No.
Site Plan Name: 1 Block No.
Project Name:
DETAILED DESCRIPTION OF WORK: ' r�`rT`" • �• °`" `", " •"_k
# of I
and Nu aw _&),-4ai i 6- incF01 &X4 S "(6 ria --' cote
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 _ Generator _ Roof Pitch
Total Sq. Ft of Construction: o- Sq. Ft. of First Floor:
Cost of Construction: $ ,CC Utilities: T Sewer _ Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:.
Name Nkdax�i_uz. Mue.1
Name: _
,1
Address:
City: F1 pct- :c State: 1
Zip Code: L3'4'9,'571 Fax:
Phone No.__7_ -` t a � (
r.
Company: Y'1ci[1F t.,itu
Addr�ys:
City: hk5l &t6l,G State: F�
Zip Code: -c'6Z Fax:
Phone No '�-1�- 4 2 i ` CO 210 b
E -Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-MailtC.,
State or County License
C.C°C i -ZCC%'_-J-'
it value of construction is 7-500 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
Name:
MORTGAGE COMPANY: _ Not Applicable
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 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 the jobsite before the first inspection. If you intend to obtain financing, consult
with lender or an attorney befor commencing work or recordiniz vour Notice of Commencement.
•
I
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t
ign �tureof Owner/ Lessee/Contractor a o Agent Owner
'gnature o trac or/License Holder
STAF FLORIDA
COUNTY OF a L'C'C',bLi ,
STATE OF FLORIDA
COUNTY OF Si-- LLC C_ V_'
Sworn to (or affirmed) and subs ibed before me of
Swor o (or affirmed) and subscribed before me of
Physical Presence or w�" Online Notarization
this t l day of 1 �L � 2020 by
V Physical Pres nce or Online Notarization
this 2U day of F 2020 by
kill
a e of person making statement.
Name of person making statement.
onally Known OR Produced Identification
Personally Known V' OR Produced Identification
y I tification
Type of Identification
uced_
Pro ced f )
t ,
o
(Signature of Notary Publi - St jdj'�mela Jones
S nature of Notary Publi - SXate of Florida)
,y, rr�
mission No. . (Seal)
C 't
r.. ,; My Commimon GG 985470
Commission No. C Cl a n x it 08I151z0 4
T
VIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Kev. 5/b/20