HomeMy WebLinkAboutMelton Permit ApplicationHif APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: a� n1lAaXy 7-i . ZOZ I
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Planning and Development Services
Permit Number:
Building Permit Application
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: Me�(k� poi
PROPOSED IMPROVEMENT LOCATION:
Address: J5 (kn t . iuf? M
Property Tax ID #: Z 7- W I - 003� - wo " -3 Lot No. I, Zr / 912-(
Site Plan Name: Mkmn dmv • Block No. �-
Project Name: wm !m��f iwok
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 _ Gas Tank —Gas Piping _ Shutters _ Windows/Doors _ Pond
Electric _ Plumbing _ Sprinklers _ Generator YndRoof 2 Pitch
Total Sq. Ft of Construction: 2�0� _ Sq. Ft. of First Floor:
Cost of Construction: $ 1-51K0. p0 Utilities: — Sewer _ Septic Building Height: 15 J
OWNER/LESSEE:
CONTRACTOR:
Name-,iW& Mtftl)
Name: S
company: �]lCQ �r�1
Address: �I v as per sty.
Address: 5i�G�da 1Pc� .
City: T_ (Ak �yxky Ck State: 1' L
Zip Code: -r") 1 Fax: "11Z.��j�i Z W3.3
Phone No. 11z-TI0-g542,
City: S"QVA- State: F-L,
Zip Code: Fax:i?2-V2.-O
Phone No 1 1 2— T 1 0 "l542_
E-Mail: 0.CCi71�.f1'f i
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail A CC()i�L.f�?�" nq(;;�-W ft11rQ
State or County License CGG l33Z3f
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 LAIN iNPORMATIQN
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
vvvrvr—M1 i..uw t tint_ t UK AFFIDViT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that noyywork or installation has commenced prior to the issuance of a permit.
wh ch is noconnflic with any representation
iHome OwnerstAssociat nirulesabylaws or andpcovenants that build
the
rictbor subject
bits such
structure. Please consult with your Home Owners Association and reviewyour 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 commencen work or recordin vour Notice DfS.= men cement.
Signature of Owner/ Lessee/Contractor as Agentfor Owner ractor/license Holder
STATE OF FLORIDA STATE OF FLORIDA ,
COUNTY OF JA'"'€
COUNTY OF
Sworry to (or affirmed) and subscribed before me of Sworn to (or affirmed) and subscribed before me of
Physical Presence oxr!y��,�3 Online Notarization _✓qP�h�ysical Presence or Online Notarization
this � day of _-3t iA ✓�A \t �y this .21 day of ,i" ;� by
Name of person making statement. e Name of person making statement.
Personally Known OR Produced Identification ' Personally Known OR Produced Identification
Type of Identification -;msv
e"Niv" N w9nn.y1PaP,4 Type of Identification
Producedrt stva 'ez �r sa�idx3 •wwo) xw
F o� o uctcs,W �a3 Produced
P 4PU%d .1 a1 - 7ir{rd ' MON % 1
ren•cvranrriaoivtnvrzv xr�.
(signature of iVotaf y public- star of_FE'nricfa ), (Signature of Notary p blic- State f Florida
Commission No. &a LExA vICTORt0. Ju
Commission No. a-= 3 Qd o al4jotary
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COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED