HomeMy WebLinkAboutMann-permit appAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date-2/3,3)al Permit Number:
91r.
0
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
I PERMIT APPLICATION FOR: I he_- hW4 I
Address:
Property Tax ID #: 1 20)01 - to Q? - Q DL4 L4 -1 M- Lo Lot No.
Site Plan Name:
Project Name:
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New Electrical Meter Second Electrical Meter
Additional work to be performed under this permit -check all that apply:
W-Ta MW
—Mechanical Gas Tank Gas Piping Shutters Windgws/Doors Pond
Electric Plumbing _Sprinkler Generator 3��/Roof Pitch
si
1 A-71011
Total Sq. Ft of Construction: to '(D5q. Ft. of First Floor:
Cost of Construction: $ .- Utilities: —Sewer — Septic Building Height
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Nameobo Ld M a.A (L'
Name: kp_Yx!-A
Company:
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Address. lC_ - 4�__
City: A -Vi efceState-ft
Address:
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Zip Code: Fax:
City:
F77-
StateLL
Phone No.
Zip Code:
Phone No
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E-Mail:
E - M a i I
Fill in fee simple Title Holder on next page if different
State or County Pcense.. (rPlj
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from the Owner listed above)
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.
MINN. N
on
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
improvem our p,broperty. A Notice of Commencement must be recorded in the public records of St.
Luce C unty and po ted on the jobsi eftirct inspe ic�z�,lf you intend to obtainn fi�ng, consult
with 1pn ran ornpv hef commencine work or r cordine vour�b Notice of Csrfimencement.
5igna ure of Owner/ Lessee/C ntractor as Agent for Owner
Signature of icense Holder
STATE OF FLORIDA�
STATE OF FLORID
COUNTY OF '�rc�:._ -+— Luc,
COUNTY OF L A A U
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Sworn to (or affirmed) and subscribed before me of
Sworn,to (or affirmed) and subscribed before me of
Online Notarization
s* al Pre=&I
this ay of2024 by
61 h�sical Pre e e or Online Notarization
th ay of C. 2024 by
Name of person m g statement.
Name of person ma � statement.ggsat
Personally Known OR Produced Ide iftflv"
Personally Known y' OProduced Identification
Type of Identification o
k
Type of Identification
Produced d
Produced
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(Signature of Nota Public- State of Florida a p� o
(Signature of Notary Public- of Florida } o 2
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REVIEW
REVIEW
REVIEW
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DATE
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RECEIVED
DATE
COMPLETED
Kev. 576726