HomeMy WebLinkAboutNeff Permit Application_000103All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 3 Permit Number;
s
Building. Permit Application
Planning and'Development5ervices
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:
PROPOSEb IMPROVEMENT LOCATION:
AddressGl( r5(� r>n 0 , _ il ,
Property Tax ID �j0 -
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
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
%VElectric tubing —Sprinklers ^ Generator _Roof Pitch
Tdtal.Sq. Ft of Constructro(n:
�� Sq_ Ft. of First Floor:
Cost of Construction: $ op
Utilities: Sewer _Septic Building Height: _
OWNE . LESSEE:
GO NTRACTO R:
Name
Addr s CI}
� City. ,vp,rN ), _��r, Stater
Zip Code; Fax:
Phone No. - - 4G3�j
E-Mail:
Name:
Company:
Address: �(� �P�►'� I�r
city: �� r,� State:.:ice
Zip Coded --�Fax:
l Phone No-:��a
F-Mailti�,. e
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
State or County License O
If VaIuP of MRGkntrtim� is 7Cf,A ..
---- -• -.+ ... rvaiuw "VL"U ui %.ummencemeni 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: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: : Not Applicable
Name:
Address:
City. State:
Zip:
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone
_Not Applicable
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 aply.
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, wails, 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 commencen work or recordine vnur Nntiro _f
Signature of
as Agent for Owner
STATE OF FLORIDA
COUNTY OF -2
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this day of _.M A -ILL— � 20 ZI by
Name of person irig statement.
Personally Known OR Produced Identification
Type of Identification
Produced
ru MICNAEL��
Signatur ota31 8620
ry c- *lor�s@!y 2023
+ q EXPlres July 28,
C on No. 9 °` "4[uDudgelNotary-';cvicus
1
REVIEWS FRONT ZONING
COUNTER REVIEW
DATE
DATE
COMPLETED
of
STATE OF FLORID ~
COUNTY OF —�
Swore to (or affirmed) and subscribed before me of
.Physical Presence or Online Notarization
this _nQ day of D1 v7UA 20,aL b
Name of person making stateme " "
Personally Known OR Produced Identification
Type of Identification
Produced
(Signature of N ic- 5 F a)
Commission N0 '0 MICHAEL RAA
r. * llr ,,..,;. ; r,G 3
c� -:s J 48.2
2i
SUPERVISOR PLANS I VEGETATION SEA TURTLE MANGROVE
REVIEW REVIEW REVIEW REVIEW REVIEW