HomeMy WebLinkAboutApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
19a, LEM U,
L ° p Building Permit Application
Planning and Development Services
Building and Cade Regulation Division Co m m e rc i a
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: 7901 Santana Ave, Fort Pierce, FL 34951
Property Tax ID #: 1301-604-0089-000-88
Site Plan Name:
Project Name:
Residential X
Lot No.
Block No.
DETAILED DESCRIPTION OF WORK:
L
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: $ Utilities: -Sewer —Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Jeff Marshall and Shyan Wojtczak
Name:
-Address: 7901 Santkina.Av�?
Company:
`rlc y,',
City: fort Pierce State:
Zip Code: 34951 Fax:"
PhbheNo: 772794,07 9.85, d
n
Address
City: Ri gE -e—
Zip`Cofde: 5
Phone No l
State:r/
Fax:
on--c—
E-Mail: shyanw7496@gmail.com
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mai[�, ,Y�
State or County License sok
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.
1_ M,
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION':
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
Address:
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 attorney before commencing work or recording your Notice of Commencement.
Signature of ner/ Lessee/tdrifractor as Agent for Owner
Sign of C ractor/License Hold r
j STATE OF FLORIDA/f
STAT F FLORIDA
COUNTY OF a !-in C_
COUNTY OF Sf Lint,
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
Physical Pre s ce or Online Notarization
_,?5:- Physical Presence or Online Notarization
this day of { �q
W`G, , 204 by
Name of person making statement.
Name of person making statement.
/
Personally Known OR Produced Identification V
q
Personally Known OR Produced Identification Y
Type of identification
Type of Ide ation
Produced
Produced
(Sig attire of Notary P , ic- State of Florida)
(Sign re of Notary Pu - State of Florida
Commission No. .- Y (SeaMMWAYWALL
ommission No. (x MY WALL
. '�
+ ;+= MY COMMISSiON # G0 92805$
My COMMISSION # W 928M
ro f5:
, 2023
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REVIEWS
FRONT
LAMS
VEGETATIO
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.5/6/20