HomeMy WebLinkAboutMouilleseauxPermitAppAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
4 0
p.
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:
PROPOSED IMPROVEMENT LOCATION: -
Address: �j ('� Cn'�l'1► n(� ��f
Property Tax ID #: �U i -1 j �� �-�-� - i �.!/ Lot No.
Site Plan Name: iycr �Por h - Un 1 3 Block No. �_
Project Name: Omit , clQ ,I x
DETAILED DESCRIPTION OF WORK:
1 g
�1,+ J� I
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 _ Shutters _ Windows/Doors Pond
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ D . co Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE:
CONTR CTOR:
Name
Name:
Address:
/
Company:V
C
City: 1 State
Zip Code: — c Fax:
Phone N� ;zl-
I
E-Mail: now
o Com
Fill in fee simple Title HolcYer on next page ( if different
Addr s: �o�
City: (�,1 Stater,,.
Zip Code: Fax: "-
Phone N
E-Mail
State or County Lice se
from the Owner listed above)
.....1,.,. „1 1� &awv LI mvic, a nL%.vnvw ivuuce ur wmmencemem is requirea.
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
Name:_
Address:
City: —
Zip:
Phone
FEE SIMPLE TITLE HOLDER:
Name:_
Address:
City:
Zip:
. Mi-
State:
— Not Applicable
i\AtruCD/ rnnrrnA9--r^n A�r.r. —
MORTGAGE COMPANY:
Name:
Address:
City -
Zip: Phone:
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
Not Applicable
State:
_Not Applicable
— -- --1 — v - 11— 1 1 11. Hppncauon is nereoy mace 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 iobsite before the first incnartinn If %inii in+n. 4 +„ -I,+-;- C:_---.
tn lencler or an attorney before commencing work or recording your Notice of Commencement.
&9AAo�__4 JkC)
Signature of Owner/ Lessee/Contractor as 6t for Owner Signature of Contract r/License Holder
STATE OF FLOP- ID��11. ,
COUNTY OF LltC l
SVrn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this day of 2020 by
Name of person makir}g statement.
Personally Known OR Produced Id fication
Produced IdentificationType of \l,��� trG O
yF'P
:FN 0 TA
(Signature of Notary Public- StaE- of FloriIIW } .41ij `A
C PUBLIC s
Commission NoC'1t'17 �(„�s�°2 Seal) 66�0 �\
i��ff•� 6 . G 9e\�, V, \N
rrn�iit ►ttt
REVIEWS FRONT ZONING
COUNTER I REVIEW
DATE
RECEIVED
DATE
COMPLETED
;ev.
STATE OF FLORID
COUNTY OF-E WC1-C
Sn to (or affirmed) and subscribed before me of
I Physical Presence or Online Notarization
this day of 12020 by
"ofers.n z
Nmaking statement.
1(/ �,,tttUnii►i�tpffff
Personally Known OR Prod ep�{j�f,
Type of Identification �N*� N issrpi,•
Produced ¢;°003 ae-?o- /Zdlg�_ - t
�F+A"�'�
(Signature of Notary Public- State':of}iJa) �•
Commission No. "j
r�rr�Unittt���`
SUPERVISOR PLANS I VEGETATION I SEATREV RILE I MREV ROVE
REVIEW REVIEW REVIEW