HomeMy WebLinkAboutLaflammePermitAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date
S i_ L U 1
Planning and Development Services
Building and Code Regulation Division Commercial
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1SS3 Fax: (772) 462-1S78
PERMIT APPLICATION FOR:
PROPOSED„ MPROVtMENT LOCATION:
Address?' ;� {. ! " . -rt
Property Tax ID a
Site Plan Name:
Project Name: ? i1,:(1 ,L/ I Ctf'rl. (r Me
DETAILED DESCRIPTION OF WORK:
.5- S
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Permit Number:
Building Permit Application
Residential
Lot No.
Block No.
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:
Cost of Construction: $ = . rb
Sq. Ft. of First Floor:
Utilities: _ Sewer _ Septic Building Height:
OWNERf LESSEE:
CONTRACTOR:
Name _tanK-
LCA I .r�,�.k�i1� �le
Name. `1 C� t'
Company: P�i r
�`
Address: 5- e fr"
City: C State:
Zip Code: ,- 1- 2 Fax:
Phone No.
Address: L( C-e
City: Vr-�,,//v/� State:��L�j
Zip Code: 3L�Fax: `%i�(� ��ICY) 1
Phone No 11'Z —LI
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail f , NTA
Icl( Don
State or County License
It value of construction is Z500 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.
SUPPLEMENTAL CONSTRUCTION :LIEN LAW INFO` AT10N..
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
improvements to your property. A Notice of Commencement must be recorded in the public records of St.
Lucie County and po ed on the jobsite bef he first ins ction. If you intend to 'btain financing, consult
h lender or 4a attorney bef4Peqqyff—mencinJ work or r co ding your NcJice of C mmen ent./
i
"J,/
ignature caner/ Lessee/Contractor as Agent for Owner
Sig ature of Contractor/License Ho der
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF in
(�l}, V./I�'
1;
COUNTY OF 0 n
Swore to (or affirmed) and subscribed before me of
✓ Physical Presence or Online Notarization
this 5 day of 6-0 n F 2928-by .7-0 1
Sworn to (or affirmed) and subscribed before me of
V' Physical Presence or Online Notarization
this � day of A-0 01 292- by 7
R, (rLdej I� h Ite c� c
h ft
Name of person making statement.
Name of person making statement.
.-
Personally Known J/ OR Produced Identi ati+
Personally Known .� OR Produced Identification
Type of Identification K
Produced
Type of Identification
Produced
Mcu,i_j 6ill (4 UO
J-4,4 100c"(A, atl_
(Signature of Notary Public- St to of Florida)
Commission No. .y)
0 r' (Seal
(Signature of Not ry Public- State of lorida)
/�
Commission No. Hi, OH 0-ncl (Seal)
eo
REVIEWS
FRONT
ZONING P.• , OR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.