HomeMy WebLinkAboutCarey.WH.permitAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 0 IZ,5-12 ' Permit Number:
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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:
PROPOSED IMPROVEMENT LOCATION:
Address: se&"�or'Se- l
Property Tax I D #: -34 I 0 - 5-08 __ 0 Z4:�,2 -000- Lot No.
Site Plan Name: I ro Rica I JS ics Block No.
Project Name:
DETAILED DESCRIPTION OF WORK: I
New Electrical Meter
A
Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit- check all that apply:
Mechanical Gas Tank _ Gas Piping _ Shutters
_Electric Plumbing _Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ 1 &1-7" 00,
— Generator
_ Windows/Doors _ Pond
Sq. Ft. of First Floor:
_ Roof Pitch
Utilities: —Sewer _Septic Building Height:
OWNERAESSEE:
CONTRACTOR:
Name KPA iio+6 L
Name: tv(c AiA 0,61 4. 1-1,141-0 rr'
Address: 33.5 i
Company: + � Pkjrn bct
City: �� GEC_ State:i=L
Zip Code: Fax:
Phone No. (Q t? I - (030 -- E�i��
E-Mail:
Address: , 7 fir'
City: Ph-Y +- 47 -- U2a.C.t. Stater
Zip Code 3q q.� Fax:
Phone No-1-77,-3 `7- �
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail JJ'JUI Ih4e fi4 - Ctnl
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.
DES IG ERJENGtNEER:_Not
Name: 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: 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 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 th jobsite before the first inspection. If you igr}tend to obtain financing, consult
witty3lenc�r or an attorney befe commencing work or recordinour Notice of camrrxisetramant
as Agent for Owner
STATE OF FLORIDA
COUNTY OF
St n to (or affirmed) and subscribed before me of
V Physical Presence or Online Notarization
this _ day of J-4 Al Q—;q 202+ by 62,0�
Name of person making statement.
Personally Known Z OR Produced Identification
Type of Identification
Produced
(Signature of Notary Pu
�. p " •. LANE COLE
Commission No. 'g' Nota ,pubt�' State of Florida
_ `= Co�mli+ilbn a GG 961089
".., ..! ' My Comm. Expires Mar 14, 2024
STATE OF FLORIDA
COUNTY OF 'S"T L Lx
Sworn to (or affirmed) and subscribed before me of
I Physical Presence or Online Notarization
this Z6 day of 2020 by ((1-cL4
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
(Signature of Notary Public- State ofN
DIANE COL
otary Public - Stat o lorida
Commission No. Commission # GG89
Comm, Expires r , 2024
fiwough National of Assn.
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