HomeMy WebLinkAboutPERMIT APPLICATION_10132 INVERNESS WAYAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: a- /- a) zt Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Commercial
Residential
PERMIT APPLICATION FOR:
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OaPOS{ED l''MP,RyOV�EMENT4LOCATION -
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Address: l (::)11j
Property Tax ID #: Lot No.
Site Plan Name: Block No.
Project Name:
DETA,CLED D�ESCRhPTItO.N OF V1/ORK;, i
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r
New Electrical Meter Second Electrical Meter
CONSTRUCTIiON ,IrNF.O.RMATIiON.
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: Sq. Ft. of First Floor:
Cost of Construction: $y Utilities: _ Sewer _ Septic Building Height:
QW, )ER/LES;S;E,E
CO.NTRACTOR:
Name
NameP_rr�.vy,i
Address: I d1�� ZYt�,r,,rn� lc ca
Company:' I�Ce fx ��a�;,y�c :z7hc
City: �� _ State:
Address:_12D i S/.cj P i 1*- "6re St
Zip Code: Fax:
City: P5 (_ State:Fl
Phone No.
Zip Code: -?L{�i 5 3 Fax:
E-Mail:
Phone No Q&00
Fill in fee simple Title Holder on next page ( if different
�7-20)-6-7�
E-Mail 1VL-O in j,
State or County License CI
from the Owner listed above)
—.,, 1 a n�%.vnucu ,VUL,F.e or Vommencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
SU.PPLEM�ENTALCONSTR,CTION LIEN` LA", l;N(E'OR11r�ATl0N -
DESIGNER/ENGINEER: _ Not Applicable
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_ - - _ -- --- -- _ -
MORTGAGE COMPANY: Not Applicable
Name:
_
Name:
Address:
Address:
City: State:
Zip: Phone
City: 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 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 before commencing work or recording our Notice of Commencement.
Signature of Owner/''essee/Contractor as Agent for Owner
atufe of Contra or/Ccense Holder
STATE OF FLORID
COUNTY OF f u&'
STATE OF FLORMA
Z
COUNTY OF
Swor o (or affirmed) and subscribed before me of
r Physical Presence or Online Notarization
Sworn o (or affirmed) and subscribed before me of
hysical Prese
this jgday of Altc 2020 by
ce or Online Notarization
this ej�"day
of 12020 by
Name of person making st�at ment.
Name of person making statement.
Personally Known l® OR Produced Identification
PersonallyKnown b/ OR Produce
d Identification
Type of Identification
Type of Identification
Produce
I
Produced !l
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(Si ure of Notary Public- State of S► rVa
•••••.Bl� 'b.SHUA S. ALBER
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(Signa ure f Nota Public- State o� lar da) J03HUA3.AQ3Eii=
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C mission No. * eel) CWWssim#yy031
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commission # HH 031
om - ion No. Se piresAugust16,2024
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