HomeMy WebLinkAboutpercival permit0001All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
IM [LM- Y-1
4
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
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PERMIT APPLICATION FOR: X -�c v I y i i�j
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.
PROPOSED IMPROVEMENT LOCATION:
Address:
Property Tax ID #:
Site Plan Name:
Project Name:
New Electrical Meter
Second Electrical Meter
Lot No. --7 , 5,( t
Block No. S R
Additional work to be performed under this permit— check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors _ Pond
_ Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction: t�
Cost of Construction: $i
_ Generator Roof Pitch
v 2—
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic Building Height: 10
OWNERf LESSEE:
CONTRACTOR: ,
Name `MON
Name: ) C h I � .
a
Company: rro ousfet'fnof
Address: '
City: 1 State:
Zip Code: Fax:
Phone No.
Address: n
City: Y Stater
Zip Code: Ll
g- Fax:
Phone No.
E-Mail K)rr P I rC Q I I
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
State or County License
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.
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
City: State -
Zip: Phone
FEE SIMPLE TITLE HOLDEP_ Not Applicable
Name:
Address:
City:
Zip. Phone:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City. State:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:
Address:
City
Zip: Phone:
OWNER/ CONTRACTOR AFPIDVIT: 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 gr 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 Cedes and k Lucie County Amendments.
The following building permit applications are exemptfrom 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 recordlne your Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORID
COUNTYOF �Q n�,L�t-t t COUNTYOF__
Sworn to (or affirmed) and subscribed before me of
✓P sical Presence or Online Ngtari;ation
this ay of �(„-t.-Z91 by
Natne of person makinment.
7
Personally Known OR Produced Identification
Type of Identification
Produced
{Signature of Notary Public- State of Florida )
MglRAESCAMIL
Commission N,r 4197-T5 3 CWN4 *GG9:
November 2
STATE OF FLORtD�,T, a� ��
COUNTY OF / (UC[ C
Sworn to for affirmed) and subscribed before me of
hysical Pres ce or Online Notarization
is day of W4 202q by
�
Marne of person makingC��✓statement.
Personally Known OR Produced Identification
Type of Identification
Produced
of Notary Public- S _ ., WERA
MMSSIDN #GG165030
EXPI ES; DEC 04, 2021
i No. B ugh 1st Stag Insurance
REVIEWS I COUNTER I REVIEW I S REVIIEW�R I REVIEW I VREVIEW�N I S REv EWLE I REV EWE