HomeMy WebLinkAboutRPetersonPermitAppAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial
Residential V
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: r
PROPOSED IMPROVEMENT LOCATION:
Address: Co�OG� �;iG1E.o�5�r� -Cern L LA tSa _
Property Tax ID #: 3(A►5-1 0(970030. 000 _9 Lot No. 1 j`l
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
R`� R. Q-00 -F L 1 S tL
P
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 \ Roof L ! �, Pitch
Total Sq. Ft of Construction: 3-7.(08 Sa Sq. Ft. of First Floor:
Cost of Construction: $ j-1,5�%5 /a Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name icl+.c+.rA V Name: Ur
4iNAf3n Li Y., Yu'u , {-
Address:Company:g -A 09 ,,46- Qe,'g
City: �ds�i S%. Lug, State:- Address:3Q(o t6f ,
Zip Code: 349.5e Fax: City: P' t(-v Si. t 4lr r e State: L_
Phone No. "77a- 4L$ -j Vic( Zip Code: 34MT:)- Fax:
E-Mail: Phone No- 9,,39-300-3-DR/
Fill in fee simple Title Holder on next page ( if different E-Mail �iY\.eA (@- ha.-mm e'r e-0,,,1
from the Owner listed above) State or County License Cf.0 t lga $
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:
DE ENGINEER: _ Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
_
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
1 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 bylaws
rules, 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 our Notice of C encement.
Signature of er/ Lessee or for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF . 1
,Sworn to (or affirmed) and subscribed before me of
Presence
Sworn to (or affirmed) and subscribed before me of
�/P�hysical or Online Notarization
this N " day of �r.b.^�e r r 202
J a b Y
Physical Presence or Online Notarization
�" Y
this ��pday of Frbn��.�.IT_ 202f by
Name of person making statement.
Name of person making statement.
Personally Known_ OR Produced Identification
Personally Known � OR Produced Identification
Type of Identification
Type of Identification
Produce
odu d
Pr-7
T-19.
01Dekned' o
cP NOTARY PUBLIC
(Signature of Notary Public- State o� NOTARY PUBLIC
�^��Y d
Commission No. (�� �(D5 %� (2 ,STATE OF FLORID
1 Comm#
/// ESTATE OF FLORID
Commission No.c7�G /613 I�omm#
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Expires 12/4/2021
F_xpires 12/4/202
REVIEWS
FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR
REVIEW
PLANS
REVIEW
VEGETATION
SEA TURTLE
MANGROVE
DATE
REVIEW
REVIEW
REVIEW
RECEIVED
DATE
COMPLETED
ev.