HomeMy WebLinkAboutSLC.Permit.APP.Kurtis Riley.All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1/14/2021 Permit Number:
cccolwell
If a' AfflIppler Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: 150 Godwin Road
Residential x
Property Tax ID #: 2307-232-0002-000-5 Lot No.
Site Plan Name: Kurtis Michael Riley 130446 Sec/Town/Range: 071355139E Block No.
Project Name: Power role
DETAILED DESCRIPTION OF WORK:
Install Power Pole for future irrigation pump
New Electrical Meter ^9 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: Sq. Ft. of First Floor:
Cost of Construction: $ 1400..00 Utilities: —Sewer _ Septic Building Height:
OWNERAESSEE `:
CONTRACTOR:
Name J� U r )i5 M , C"h 0 fj
Name: E r-kr. dvii S r.
Address:_ Z 4 2 1V W 13d1 L--i2i-e
Company: r.i-etv-ric c>e L"(,rf_CAW1
City: t L & LA Li -C State: F)-
Zip Code: 3� q 8 Fax:
Phone No.
Address: � '2 V La S -e4 t LIU-e n U. E'-
City: R71� ei'-eAC.Q_ state: ILL
Zip Code: '4'1 it D-- Fax: NO
Phone No —7 4 lv S- 23 (o 3
E-Mail:
Fill in fee simple Title Holder on next page { if different
from the Owner listed above)
E-Mail oes u,s& � 60 r"
State or County License (-) 3 0 0 -Z'Z v
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
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:
City:
Address:
City:
Zip: Phone:
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 contiict 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 attorney before commencing work or recording your Notice of Commencement.
Signa re of 0 ner/ Lessee/Contractor as Agent for Owner
Signa re of ontractor i nse Holder
ATE OF FLORIDA
TATE OF FLORIDA
OUNTY OF -5� C° r e
COUNTY OF%.Z cR e
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
�Ph ylical Presence or Online Notarization
A -'Physical Presence or Online Notarization
this,=day of -ra i Lt c, e !�r 2020 by
this, day of a]a t4 ce.&1- K 2020 by
JSe A 4 ',�'7' 1-74
Name of� making statement.
Name of person making statement.
Personally Known l"" OR Produced Identification
Personally Known j-*' OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature ofNotary Public- State of Florida }
{Signature of Not y PuW-ellf F o it
Flnr
Commiss (�$al)
Notary P is Tate of florida
Commission No.Randoi�aniei
My Cmion GG 352355
My CoMMISS4 GG 352355
Expires;107l2073
Expires 08117712023
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Rev.5/6/20