HomeMy WebLinkAboutLafferty Permit AppAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date
Permit Number:
S-r" U2 cu E
V 1770-76W�IJT . . . . . . 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: qta-�-F
PROPOSED IMPROVEMENT LOCATION:
Address; 4.13
PropertyTax lD#: Lot No. ItR
Site Plan Name: Block No.
Project Name:
,T
DETAILED DESCRIPTION OF A A I - x r - - I'Vvt�l-' I I
Is
New Electrical Meter Second Electrical Meter
I CONSTRUCTION INFORMATION: I
Additional work to be performed under this permit -check all that apply:
—Mechanical — Gas Tank —Gas Piping Y Shutters Windows/Doors Pond
Electric Plumbing Sprinklers Generator
JzKoof 4//2 Pitch
Total Sq. Ft of Construction: 12.o co
Cost of Construction: $ 11 A tO 00
Sq. Ft. of First Floor:
Utilities: —Sewer _Septic Building Height:
OWNERAESSEE:
CONTRACTOR:
Name RM-Aa LLA��
Name:
Address: U00+, P/UM&A- [A)
I
Company: di) 10�L kqC4
City: State:
Zip Code: 349-�Tl Fax:-
Phone No. --
E-Mail: n�ft
Address: Nie-MLVc (
PC City: —,State:5c
Zip Code: Fax: N
Phone No -:Iq'?_ (0 Z Pp
Fill in fee simple Title Holder on next page if different
from the Owner listed above)
E-Mail
State or County License
If value of construction is 2500 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: I
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:_
Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
_Not Applicable
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 attorngybe_fore-Qommencing work or record-ing your Notice of Commencement.
Signature
STATE OF FLORIDA
COUNTY OF_ _ 165�
as Agent for Owner
Sworn to (or affirmed) and subs ed before me of
Physical Pre ence or Online Notarization
this e5�day of �' 2020 by
.'�_7ckt�L'1 a'4e
Name of person making statement.
Personally Known OR Produced Identification
T Identification
Produce C)L_\
(Signature'of Nota y Pu lic- State of Florida )
Commission No.��%�1
Notary Public State of FWWa
Pamela Jones
Expires o8/15/2(12
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Signature of Contractor/License Holder
STATE OF FLORIDA�i
COUNTY OF 19-
Sw�hhylcal
irmed) and subscribed before me of
nce or Online Notarization
this nday ofY4l�4f 2020 by
Name of person makin:�Mucecl
Personally Known Identification
Type of Identification
Produced-- �J
(Signature of Notary Public- SikLejf Florida )
Commission No. Pupfict#Florida
a4 Pamela Jones
My Commission GG 985410
PLANS
RE EW (V REVIEW REVIEW REVIEW