HomeMy WebLinkAboutSchleif Permit ApplicationAll APPLICAqLE INMUS
T BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: t)Permit Number:
snr) UEC
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Planning and Development Services
Building and Code Regulation Division Commercial
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Residential
I PERMIT APPLICATION FOR: 6 \ a4 � 4 U4 � 7-S t_ � It -e_ � WK_ �X -Y I
Address:
NJ
PropertyTaxlD#: Lot No.
Site Plan Name: Block No.
Project Name:
New Electrical Meter Second Electrical Meter
Additional work to be performed under this permit- check all that apply:
—Mechanical — Gas Tank —Gas Piping
— Electric — Plumbing Sprinklersf
Total Sq. Ft of Construction,
Cost of Construction: $ LY-0-7L Ut
Name_V
Address:
Shutters Windows/Doors Pond
Generator Roof 44h��Pitch
Sq. Ft. of First Floor:
ilities: — Sewer _ Septic Building Height: q
State: El
Zip Code: �NYrJM,L Fax:—Nzy.*��
Phone No. 110-) -
E-11ail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Name: V-�
Company: 1-1—
Address:'4S cat
City: State:
Zip Code: Fax:
Phone No 9
E-Mail i'Vv_ ,
State or County License U0 it2)3sio�fc) —1
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 YOUR PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER Oft AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF CQIOMENCEMENT:'
Signature of
STATE OF FLORI
COUNTY OF
as Agent for Owner
W
The for oing instr nt was acknowledged before me
this day of , 20-� I by
Name of person making statement.
Known OR Produced Identification
Type of
Commission No.
REVIEWS
DATE
RECEIVED
DATE
COMPLETED
_ CgMPBELL
tart' p1=altWtr of Florida
Commission .EDies Sep 4, 2024
COUNTER REVIEW ( REVIEW
Signature of Contractor icense Holder
STATE OF FLORI
COUNTY OF 0
The for oing instr t was acknowledged before me
this � d of 3 ��A _, 20Q by
gms
Name o person making statement.
Perso ally Known OR Produced Identification
Type f Identification
Commission No.
Public- State of Florida j
�'i; MA!�'� ELL
• Notary Public St, a of Florida
� "I Commission N HH 034737
PLANS
RE 011
EW I v REVIEWEVI; EW _ REVIEW
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