HomeMy WebLinkAboutKlemens Permit Application09012020All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
Building. Permit Application
Planning and "Development Services
Building and Code Regulation Divtslon
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Commercial SU' Residential
PROPOSEQ IMPROVEMENT LOCATION: Ia,1& i Q 8T I-4cCI0Cv
Address: I D(oTQ Q cA.o.^— t.
CXv , C\ i WQ G A i �i A r. iv, L �CrC.
Property Tax ID #:
Site Plan Name:V
Project Name: i� r p rVL'01 Z ,
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Lot No.
Block No.
I'll 6 Vflfl f1 6 V]
Additional work to be performed under this permit -check all that apply:
/ —Mechanical _ Gas Tank ^ Gas Piping _ Shutters Windows/Doors _ Pond
��ectric �umbing —. Sprinklers ^ Generator Roof Pitch
Total.Sq. Ft of Construction: Sq. Ft. of First -Floor:
Cost of Construction: �L-( I�(,7 . CX� Utilities: —Sewer
Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
Name: IN
Address: (_UL49b O GL._ b
r t 0(0
Company:
Address: 5
City: 1'�C 0 'k D-State:R_
Zip Code: A('QSP_!_ Fax:
City: _ Stater
Phone No. r1,9 (oq- J-b(o, 4 (,,,7(o
Zip Code: � L- S'� Fax:
E-Mail: Q�ffl"
�
Phone No Qr%a. 7 ,_-_WS_
Fill in fee simple Title Holder on next Vage
(if different
E-Mail I Lb, P (vm .cc c-J
State or County License
from the Owner listed above)
-- -- �•-�•a••-�••�•• •� u��W, 111u«, a.,%cwrsuru nonce or commencement is requwrea.
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:
Zip: Phone State
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 Associationand 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, wails, 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 before commencing work or recordin our Notice of Commencement.
LOU
Signature of Owner/ essee/Contractor as Agent for Owner Signat r o Contractor QLer
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF ,1 COUNTY OF ST.
Sworn to (or affirmed) and subscribed before me of Sworn to (or affirmed) and subscribed before me of
Physical Pre nce or Online Notarization -� Ph sicaI Pr ence or Online Notarization
t is day of 20 by this day o 20,:�_bby
A_J
Name of person rnaJTg statement. Name of person making statement.
Personally Known OR Produced Identification aC Personally Known _ OR Produced Identification
Type of Identifition
Produced pL Type of Identification
Produced
(Signature of Notary Publi State of Florida } (Signature of Notary Pu a of F rida }
Comm, I(r5009 LRAAZ Commis ' ¢ (Seal)
" * Commission # GG 318620 » Aft
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COUNTER REVIEW REVIEW REVIEW REVIEW A6 � t
DATE
RECEIVED
DATE _F
COMPLETED
ev.