HomeMy WebLinkAboutPERMIT APPLICATION FOR Mulchand GopieAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: I /Li 202.1 Permit (Number:
O d 1614
P • ...
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
011
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Property Tax ID Lot No. —
Project Name:
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
Electric
Gas Tank — Gas Piping
Plumbing _ Sprinklers
Total Sq. Ft of Construction.
Cost of Construction: $ 11n,�9y0• nn
_ Shutters _ Windows/Doors Pond
_ Generator Roof Pitch
Sq. Ft. of First Floor:
Utilities: —Sewer Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
Name:
Address:
Company: E
City: State:
Zip Code: Fax:
Phone No.
E-Mail:N IQ
Address: g/
City: I f State:
Zip Code: Fax: N/A
Phone No 0 LA .`I I on
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:
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: x Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: A Not Applicable
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY: y,, Not Applicable
Name:_
Address:
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 instaliation 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.
Il In consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
11 in accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
II The following building permit applications are exempt from undergoing a full concurrency review: room additions,
dctures, ""im"iing pools, fences, wails, signs, screen rooms and accessory uses to another non-residential use
II WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in Davine twice for II
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with lender or an attorney before commencing u,nr4 or recordina vnnr Wntiro of rr%MM'Dnr•embnt
InAlm
Signature of Owner/ Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF ST ixuI— COUNTY OF 61 LU
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this la day of 2020 by
Name of person making statement.
Personally Known UK Producea identlfrcatfon..,>
Type of Identification
Produced Q939ff RS JCEN
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this _ day of 202Q by
J �,S Sl�' MORRI� �
Name of person making statement.
Personally Known ?�__ un Producea laentlrlcauon
Type of Identification
Produced
,e L— &±my"
_r'a0
(Signature of Notar
Public- State of Florida
(Signature of
& Florida
Lommisslon No.
�,°
' `�'-,
CALEB REDMAN
Lary Puf -Vats of Florida
Commission N ,,
CALEB R�f N
Public-S `Rf
Commission A GG 327951
Florida
" '_`- Commission Ill GG 327951
Mv Commission Expires
S .Pp'AV
C
AprI125
2023
pril 26, 202�
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