HomeMy WebLinkAboutSOKOLOWSKI APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Permit Number:
Date:
-r,4
Building Permit App
Planning and Development Services Commercial Residential
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: P4e- �bl� n� -�af►� C��e�
PROPOSED IMPROVEMENT LOCATION:
Address:
Property Tax ID #
N
Site Plan ame.
Project Name: So b L`I
DETAILED DESCRIPTION OF WORK:
eliff-- POW
New Electrical Meter- -________—
Second Electrical Meter
CONSTRUCTION INFORMATION:
Lot No.
Block No.
Additional work to be performed under this permit- check all that apply windows/Doors Pond
Gas Piping Shutters — —
_Mechanical _Gas Tank _ — Pitch
Plumbing _Sprinklers —Generator Roof ____ __ -
_ Electric _ g
Sq. Ft. of First Floor:
Total Sq. Ft of Construction:
utilities: ,Sewer —
Septic Building Height:_____ __—
Cost of Construction: $
CONTRACTOR:
OWNER/LESSEE:
Name:
Name Company: ryl:
Address: fin` s Alit
L Address: 4 9 tj CA' �.'
city ������"' State: y� State:�L
City: ` 2� r C-e-
ZipCode:�a�`r� Fax: r � S� Fax:
Zip Code:
Phone No. 1102 t9)
Phone No� D �
E-Mail:�'
Fill in fee simple Title Holder on next page (if different E -Mail b 2 8
from the Owner listed above)
State or County License
If value of construction is 2500 or
RDcommencement Notice of s nt is required.
If value of HAVC is $7,500oeRECORDEDNoce of rqure
SUPPLEMENTAL CO STRUCTION LIEN LAW INFORMATION: Not Applicable
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY:
Name:
Name: ` Address:
Address: State:
City: C�+� and State: L City: phone:
Zip: ��� (( Phon C)l_2-,�-Ic4 l`�____ Zip:_
Not Applicable
FEE SIMPLE TITLE HOLD R: ✓ .—Not Applicable BONDING COMPANY:
Name:
Name: Address:
Address: City:
City: Zip: Phone:
Zip: Phon
OWNER/ CONTRACTOR FFIDVIT: Application
is hereby
is nano a obtain
paper mit to do the work and installation as indicated.
I certify that no work or install tion has commencedprior
St. Lucie Counnyimak th am ap sentleiHotne OwnerstAsgociat permit
rulesabylaws or and covenants enholder
n d that maydrestric subject
prohibit such
which is in co ff�l Y
structure. Please consult with Pur Home Owners Association and review your deed for any restrictions which may appy.
In consideration of the grantinig of this
hi sree Florida Building Codes and St. Lucie Couree that I illl, in all Amendmects, perform the work
in accordance with the app p p
The following building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures, swimmi Ig pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
lt in
WARNING TO OWNER: Y urfailure
t A Notice of Commetwice for
n ement must be a Notice of Commencement recorded n the publ c records of St.
improvements to your property.
Lucie Cou ty and posfied on the �obsit men�in the
work or recto dinn Tour of ce of Commlencement. consult
with len er or an aitgrne before com
Signature of owner/ Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA COUNTY OF
COUNTY OF _0 cC
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of physical Presence or Online Notarization
Physical Presence or _ jOnline Notarization J 2020 by
this .;Z day of
, 2020 by this,,U day of
Name of person making statement.
Name of person making stat -ment. _/ OR Produced Identification
Personally Known
Personally Known ,-'OR Produced Identification Type of Identification
Type of Identification Produced
Produced ;�� F.
"v v� •. STELLA M HUNTER z ;• ,• F' odda
Notary public -State of Florida " '
sq,or. (Signature of No iu'bTrz- State of Florida )`.`13. 2023
of Fl oma;
(Signature of Notary Pu i " F� ; My C" Expires Jan 23, 2023 3i ;, ,. ota:y Assn.
Bonded throe2h National Notary Assn.
Commission No.
Commission No.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA REVIEW LE MANG
WVE
COUNTER REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED