HomeMy WebLinkAboutLyshon Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
COUNTY
• R I ,
Planning and Development Services
Permit Number:
Building Permit Application
Building and Code Regulation Division
2300 Virginia A ven ue, Fort Pierce FL 349,g2 Commercial Residential
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: 20 57 , f`'h-,�,! /)13 Z
Property Tax ID #:
Site Plan Name: i/ 14
Project Name: L F1t/ .4_
DETAILED DESCRIPTION OF WORK:
New Electrical Meter _.Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed
Mechanical
0 Lot No. L/ 6
Block No.
under this permit —check all that apply:
_ Gas Tank — Gas Piping
— Electric — Plumbing _Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ 7 e , 0
OWNER/LESSEE:
<:: 6 k e-,
Shutters Windows/Doors Pond
_ Generator — Roof --- Pitch
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic Building Height:
Name 411 '//!C.
Address: 0
City:
Stater/
Zip Code: 2f✓ 2 Fax:
Phone No. Z - j 6 - Q 76/
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
CONTRACTOR:
Name: P�G Ccd���-
Company-
Address:/f .
City: f c� State/ --
Zip Code: S Fax:
Phone No "7 z -- 7&�
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.
s Not Applicable
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER:
Name: — Applicable
Address:
City:
Zip: Phone:
MORTGAGE
COMPANY:
Name:
��. Nat Applicable
Address:
City:
Zip: Phone:
State:
BONDING COMPANY:
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 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
structure. Please consult with your Home Owners Association and review our deed for an restrictions which may apply,
y y y restrict or prohibit such
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 record; our Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF �
Srn to (or affirmed) and subscribed before me of
Physical Pres a or. Online Notarization
this day of 1� 2024 by
Name of person making, statement_
Personally Known v` OR Produced Identification
Type of Identification
Commission No-171Y
REVIEWS FRONT
-__JCOUNTER
DATE
DATE
COMPLETED
N1aaorNiELLE B. JEWELL
Notary Public - State of Florida
M�scion # GG 937394
am . Expires Dec 5, 2023
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF
Swocfi to (or affirmed) and subscribed before me of
Physical Pres �e or Online N tarization
this t day of .� G�' +,"! �' - �a2; by
Name of person making statement.
Personally Known I/ OR Produced Identification
T�kte of identification ----
Pro�uced .�
(S19 Eure of Notary P lie -,St , ri a
rf r DANIELLE 6. JEWELL
T }; ` Liotar Puhiie - State of Flor
Commission No. 5
( emission # GG 937394
My Comm. Expires Dec 5, 20
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