HomeMy WebLinkAboutPermit appAll APPLICA LE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ld Z Permit Number:
� ° B I Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential X
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 4624553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION: /
Address: 1'Z1\Dq V_'Wke) enA CUr�e, Psi , 3L1G
Prope, tyTaxlD#: uuZ2-�dZ OaZI-ci00 Z LotNo.�
Site Plan Name:
Project Name:
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
,sElectric
_Gas Tank
_Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ 24ab� 1
_Gas Piping
_Sprinklers
Block No.
_Shutters
_Windows/Doors _Pond
_Generator _Roof Pitch
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
)
G(ZI
Name: C (ni
Addre( :\2\IDcl lkyeirwr`A C_ri
Company;FQL \ OMQ_
SQJ�1ei�S?�
City: _ �( SL State: AL
Zfp Code: CI254 Fax:
PhoneNo. --(U`T 5-I �l�
Address: C I \,6100
City:
Zip Code:
Phone No `5 - `ILil
State:=
Fax:
4SI b
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
&Mail er)f\ i of .'a 1 WNP t
. eol ,A
State or County License GC 1 ;O6 Q ZZX
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
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:
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 attorneybefore commencingwork or reeccor�din. our Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/LiceVrse Holder
STATE OF FLORID, 'I —
COUNTY OF T Oy` t\A �& 1
STATE OF FLORI
COUNTY OF (%1h%L .
Sw rn to (or affirmed) and subscribed before me of
Physical Presence or.Online Notarization
this 10 day of Vtb 2020 by
Sworn to (or affirmed) and subscribed before me of
Physical Pr Rnce or Online Notarization
this (1 day of� 2024 by
)tea C'�rn,h
c C01
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Produced
Type of Identification
Produced
Produced
XCn 7
(S gnature of Notary Public- State of Florida)
Commission No. �bcsbteorrbnda
Stephanie Kussrath
• W C' ,,, Aon HK 025509
(Signature of Nota yi - t cry rumu OL a FwPq �
f Stephanie Kussratn
Commission No. try CommssbgdlEjQzs509
w plro� 1 1121
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