HomeMy WebLinkAboutZebrowski-Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date _-0 4tq a" Permit Number:
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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: 77� LD 1,ciii,QkL 3yg51
Property Tax ID q:
Lot No.
Site Plan Name:
Block No.
Project Name:
Kg��Y
QDiy
DETAILED DESCRIPTION OF WORK:
1,7
New Electrical Meter Second Electrical
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:
Utilities: _Sewer _Septic Building Height:
OWNfR/LESSEE:
CONTRACTOR:
Name
) kv 2t\ocow'k
Name: X)rw\ U0-?(w G%
Address:
`�SS O P�kv d •
Company: N7M'V% ConSkCW 1:O./ 1 L('
City: 1. •let State
Zip Code: SA \S aL Fax:
Phone No. /) i
Address: 1�t�� SW GS-,
City: ';r�NL-. tate:�
Zip Code: 3 Fax:
Phone No L� o93
E-Mail: �J%_�
Fill in fee
from the
simple T(tle Holder on next page (if different
Owner listed above)
E-Mail Rci(
State or County License
Ir vawe of construttron is 2500 or more, a RECORDED Notice of Commencement is required.
H value of HAVC Is $7,500 or more, a RECORDED Notice of Commencement 8 required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: — Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name Name:
Address. Address:
City. State: City: State.
_ _
yip _ Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name
Name:
'Address:
Address:
k
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 curry that no work or installation has commenced prior to the issuance of a permit.
St Lucie Counly makes ro 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 conscit 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 fcl'owing building permit applications are exempt from undergoing a full concurrency review: room additions,
accessary 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.
Lucl Caunty and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
with Wder or an attorney before commencing work or rewirding your Notice of Commencement.
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Signaw f er/ Lessee/Contractor as Agent for Owner
Sign o Contractor License o r
STATE LORIDA �``11 I
S F FLORIDA
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COUNTY OF N • L . tnt l
COUNTY OF
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i Sworn to (or affirmea) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
�ysical Presence or Online Notarization
'Physical Presence or Online Notarization
tha�\�L day of 202Q by
thi1s/J� day of+/�l /kPn . 202M by
jI Name of person making statement.
Name of person making statement.
' Personalty Known OR Produced Identification >�
Personally Known OR Produced Identification
Type of'den .canon
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Type of Identificatiopn ,1
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DATE
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' DATE
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