HomeMy WebLinkAboutLamphere Permit appAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date.
- f---- — - - -.-
P
Permit Number.
Bu10
ilding Permit Application
Planning and Development Services
Building and Code Regulation Division'
2300 Virginip Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 452-1578
PERMIT APPLICATION FOR:
Commercial Residential
.... I
PROPOSED IMPROVEMENT LOCATION:
Address:
PropertyTaxlD#: �Ji�—CIS-
Lot N o .
Site flan Name: Block Na.
Project Name.,
D
DETAILED DESCRIPTION OF WORK:
A'
New Electrical Meter Second Electrical Meer
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit— check all that apply:
Mechanical
Electric
Gas Tank
Plumbing
Total Sq. Ft of Construction:
Cosh of Construction: $
Gas Piping
Sprinklers
Shutters
Generator
Windows/Doors Pond
hoof Pitch
Sq. Ft. of First Floor:
Utilities: Sewer Septic Building Height:
OWNER/LESSEE. CONTRACTORS
Name f I' e: i.a+/? &11;
a22
Address.Company;-��
c 4 , ity
end State: Address: L-� �
Zip Code: Fax:City:State:
f
Phone No. 41 0 -W^ Zip Code--. .
�.� . r
E-Mail: Phone No Q14n,
Fill in fee simple Title Holder on next page if different E-M i I -ae-
A111-1
r.
from the Owner listed above) � t e CountyLicense
!i
vidme
or
rcons uLmon is
zzouu or more, a tt KUtV NCYjce of commencement is required.
If
value
of
HAVC is $7,500
or more, a REGORGED Notice of Commencement is required.
SUPP-LEMENTAL CONSTRUCTION LIEN LAWINFORMATION.-
DESIG NER/ENGI NEER: _Not Applicable MORTGAGE COMPANY.: Not Applicable
Noma•
Address:
City:
Zip: 3k, yr3_
Phone t'
FEE SIMPLE TITLE HOLDER:
L
State: �_
7
Not Armlicable
Name:
Address:
City:
Zip: Phone:
Address*
City: State -
I ; Phone.
Not Applicable
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a hermit to too the work and installation as indicated.
I certify that no work ar installation has commenced prior to the issuance of a permit.
St. Lucie County mikes -no representation that Es granting a pe rm it will authorize the hermit harder to huilcf the subject structure
which is in contIict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. pI ease consuIt with you Mome Qwners RssocFation and review your deed for any rest ions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I wild, in all respects, perform the work
in accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The foflowing build jng permit appiications ire exempt from undergoing a full con currency review: room additions,
accessory structures, swimming profs, 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 mush be recorded in the public records of St.
Lucie County and posted an the jobsite before the first inspection. If you intend to obtain financing, consult
with lender or..an attorney.before commencin work or recording our Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OFtoe COUNTY OF
Sworn to to r aff 1rmedj and subscribed before me of Sw rrto (or affirmed) and subscribed before me ofical �rr� Notarization � Physical Presence or Online Notarization
this day of 2020 by this day of _ _ _ , 2020 by
MUM
-
Name of person making statement. Name of person making statement,
Personally Known OR Produced Identification Personalty Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
^ r
'lid
f S ig n N
re o� otary Public -State of Florida j (Sazure of Notary Public- State of Florida �
� Y ���!A �. FRANCO �
Commission No.':� � s (SeA� Z,6...3 � ��� ��.RrFS,� � .•.,�f�commission #Cammissior� N
* ` � �xplresA�r�! �9, 2�23 � fiRANCO
. * cammmm
issiv� �
o�� ��t�ded hnt 9u 9�
�G 32
EZONor•�'� :`��F ��.�F` � i�r� s April fig, 2023
REVIEWS FRONT iNC SUPERVISOR PLANS VEGETATION SSA TURT���T� s� IG�l�E
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.576/20