HomeMy WebLinkAboutHallman_Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
O�
' ° . 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:
Address:
Property Tax I D #i:
Site Plan Name:
Project Name: J
4.5II 8/5- 0005 - 000 `8
New Electrical Meter Second Electrical Meter,
0
Lot No.
Block No.
Additional work to be performed under this permit— check all that apply:
Mechanical , Gas Tank _ Gas Piping _Shutters Windows/ oors _ Pond
,/ Electric Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction:
Cost of Construction: $
5q. Ft. of First Floor:
Utilities: —Sewer Septic Building Height:
Name C>UJ1Jl III
Address
City: t110� State:
Zip Code: �!N �j+ Fax:
Phone No.
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Name: DMI1 V U
Company: e j
Address: 55$ N W Al 66 Alt
City: S�3lQra- state: Fl
Zip Code: Fax:
Phone No 2
E-Mail
State or County License�2 g 52
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.
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DESIGNER/ENGINEER:
Not Applicable
MORTGAGE COMPANY: Not Applicable
Name: S fi d/d
Name:
Address: 5"49 NW
!GP✓ 1W
Address:
City: Uu r
State: L
City: State:
Zip: Phone
$ .0(025
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 mstauanon d] !f 1U1C5LC_.
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 Cgrinty and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
withJ6nder or an attorney before commencing work or recording your Notice of Commencement.
Owner/ lksset-/Contractor as Agent for Owner I -5ipature
STATE OF FLORIDA
COUNTY OF
Sw n to for affirmed) and subscribed before me of
17 Physical Presence or Online Notarization
this J day of Y Y
Name of person making
/statement.
Personally Knowny OR Produced Identification
Type of Identification
Produced
(Signature of Notary Public- State of I
1 U -'"""" `•. BIANCA FAH
Commission No. f"I D 1�Ii0y �+ NoC�iblonNtHI
a d'' My Comte. Expires
STATE OF FLORIDA
COUNTY OF
Swn to for affirmed) and subscribed before me of
sical Presence or Online Notarization
this Ph day of 19315 by
2D2_%
W04
Name of person making statement.
Personally Known,/ OR Produced Identification
Type of Identification
Produced
&64A,A,"_
e of Notary Public- State of FI i
)f R r
� �
a 6, 2024 s on No. 'Q BIANCAFA
)d 75, Notary Public - s
Coission A
AtVComm t�ti4
onded through Nation
REVIEWS FRONT ZO MPERVISOR PLANS VEGETATION SEA TURTEF
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
COMPLETED
Florida
1164
2024
ry Assn.
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