HomeMy WebLinkAboutPermit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: AWS Permit Number:
O
1 ® n -
Building 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: elec-�n'cw
PROPOSED IMPROVEMENT LOCATION:
Address: 60101' ► W L n
Property Tax ID #: EY@f)--]01Lot No. _
Site Plan Name: Block No.
Project Name: rnUkA" Plink
DETAILED DESCRIPTION OF WORK:
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:
Cost of Construction: $ 1,5C)C)
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic Building Height:
OWNERAESSEE:
CONTRACTOR:
Name- fAQAY�",-'Rr0 r
Name:
Address:�
Company:
City: 1 !} �. f. 00- State: ��
Zip Code: H95� Fax:
Phone No. 7Z16)-(p IsaS
_ElC'I(
Address:?C Ro�(
. City: )(-- ( c'k- Stater
Zip Code: Mks Fax:
Phone No 110- 3�-I DQ 6
E-Mail: • r ou\l (- Uxn
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail elfC�rIC �(1C .'���_� ( (1ym-0 -COM
State or County License Fc— 3s
- - -..._ __ ..�....�.... ivUL Lu ui %-un mumemem: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:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: Not Applicable
Name:
Address:
Address:
City:
Zip: Phone:
City:
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 OWNE . ur failure to Record a Notice of Commencement may result in paying twice for
improvement o yo r property. A Notice of Commencement must be recorded in the public records of St.
Lucie Coun and p sted on the 'obsite before the first inspection. If intend to obtain financing, consult
with I n r or a ttorne e r commencing work or recordin ur otce of Co cement.
Sign ture of Owner/ Lessee ontractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF sni io}- uyit
STATE OF FLORIDA
COUNTY OF ' X*Wde-
Sw0jno n to (or affirmed) and subscribed before me of
Physical Presence or � Online Notarization
this 4L day of �_ 2020 by
Swvytn to (or affirmed) and subscribed before me of
V Physical Pr Bence or Online Notarization
this ] day of 2020 by
yflff Umt
Name of person making statement.
Name of person making statement.
Personally Known I//OR Produced Identification
Type of Identification
Produced
ng
Personally Known V OR Produced Identification
Type of Identification
Produced
(Signature of Notar Public- State of Florida)
ALIS�I FIq�JSON
Commission No.
COMMI GG970043
�P',,' EXPIRES: March 16, 2024
(Signature of Notary P
Commission No.
e of Florida
�'" ` "
,. YP ISO HANSON
,. MY C0 N # GG 970043
;;R P EXPIRES March 18, .024
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