HomeMy WebLinkAboutJKLEIN PERMIT APPAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 9, 111 ) ?�'b�'t Permit Number:
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: So
k
PROPOSED IMPROVEMENT LOCATION:
Address:
eg t
LL
V/
Property Tax ID #: 3N 15--70 P-DDa?8-DDD -a Lot No. 15-7
Site Plan Name: Block No.
Project Name:
I DETAILED DESCRIPTION OF WORK: I
EN
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
_ Electric _ Plumbing ! Sprinklers
Total Sq. Ft of Construction: 2q .,AD 5 Q
Cost of Construction: $ 9l i F3 (v. LID
_ Shutters _ W� innddows/Doors
_ Generator ►/ Roof
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic Building Height:
Pond
Pitch
OWNER/LESSEE:
CONTRACTOR:
Name::Y0V, ,. A. KLe-Lv.,
Address: (e,703 ID, at n&j✓ le-cr,
City: Part S+, LL ,y.t. State:FL--
Zip Code: 3 Fax:
Phone No. 4014 —," tog
Name: Qra..ng6ny;yKt4,tL\/r_
Company: ti6~\&r 9,PA!24
Address:3o?(o, YillwAy4_
City: PDc f St .Luc: t. State:F_L'
Zip Code: 3Ei5 S;t, Fax:
Phone No —17R — 30 / — J1(o3
E-Mail i *.Q hcimrnerO
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
State or County license GLC- Il $
n val.,e v1 wnauucuvn 1b cwv yr mere, a nrcurcuru rvouce or 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 TITLEHOLDER: _ 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 attorne befor commencing work or recording your —Notice of Commencement.
Signature of wner/ Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF 5f. Ltc. COUNTY OF S-t, LUX-o t!.
Sworn to (or affirmed) and subscribed before me of Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization J Physical Presence or Online Notarization
this _ day of 2020 by this _ day of 2020 by
Name of person making statement.
Personally Known OR Produced Identification
Type of Id t' ication
Produce
J
(Signature of Notary Public- State ofGina DeRmedico
_ r� CT NOTARY PUBLIC
Commission No. �� f� �J O q STATE OF FLORIE
' Comm# GG165138
Q�ano�r. t% tl 164:4t ✓t.r
Name of person making statement.
Personally Known )e OR Produced Identification
Type of Identification
(Signature of Notary Public. State of FIoP , NOTARY PI
STATE OF
Commission No."/46732 t• (• F: Gomm#GG
11
7MCF 19��' Expires 12
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
DATE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
RECEIVED
COMPLETED