HomeMy WebLinkAboutDElderPermitAppAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ZG-YNt� a I , 12S-t I
97.
L�LvILLO)t1:'-
Permit Number:
Building Permit Application
Planning and Development Services V/
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: bOuRla-5 Etelir
PROPOSED IMPROVEMENT LOCATION:
Address: (o-1 0*7 ► erc. Por-1 S-� �cGoL F� y�S a
Property Tax ID #: 3(4(57-7%v- iDga,7-0oo -S" Lot No. /S(.-
Site Plan Name: Block No. I
Project Name:
DETAILED DESCRIPTION OF WORK:
R R R a-&* q 0 a
hl a ..� e i 1s.1 G n L -- ► L I . _ ._ I i i 7 .n ,.J ....- — , i -rv% ,Ae
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
Total Sq. Ft of Construction:
Cost of Construction: $ ZS (On . 2}
Generator v Roof tZ Pitch
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic Building Height:
OWNERAESSEE:
CONTRACTOR:
Name Z�OqzaG-5 E taltr
Name: arg'tI d2.'wj!
Address:_(,?0"7 biGI6A9j2r-,Uer
Company:14a^me.-RA!14.Qa5IP/W�-.'wL TAe.
City: Per'-(- 6+ L"4-State:F•LL
Zip Code: 3(4435'a Fax:
Phone No.95-{- (o l R -33i$
Address:32(. Rpltl ,qvG
City: edr t $ - Ltc_�j-r- State: P'C-
Zip Code: 3 L113S. _ Fax:
Phone No 939'3D0-,Raq (
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail a n haan rne�ry •GOM
State or County License CCG 1331-3?
vaiuc ui wiuuuwun is caw or more, a KtLUKutu Notice of commencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
I SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
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 attorney before commencing work or recording vour Notice of Commencement.
Signature Owner/ Lessee Co ractor as Agent for Owner
Signature o Lic e
STATE OF FLORI A
S L
STATE OF FLORIID,4
Li
COUNTY OF . uc_I e..
COUNTY OF �� r
Sworn to (or affirmed) and subscribed before me of
Physical Presence Online
Sworn to (or affirmed) and subscribed before me of
or Notarization
this day
_ Ph sical Presence or Online Notarization
Q
of , 202# by
this IbF day of fit V.A,Cc1 2024 by
'3rky1d e*1
$ML4Jyv1 V r 11 h-CC:uyf-
Name of person making statement.
Name of person making statement.
Personally Known K OR Produced Identification
Personally Known S_ OR Produced Identification
Type of Identifiot4or
Type of Identification
Produced
Produced
(Signature of Notary Public- State of Florida)
(Signature of Notary Public- State Dehnedic0
D&nedico
Commission NoCC? I(P713�6 (�OTARYPUBLIC
tofridabi�aGina
c �3NOTARY PUBLIC
TATE OF FLORIDA
Commission No. ,S 90TE OF FLORIDA
. Comm# GG165138'Cam#
GG165138
NCE 9Expires
121412021
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