HomeMy WebLinkAboutNew St Lucie permitAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number.
SIT. U1UC
Building PP Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial ✓ Residential
2300 Virginla Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Address: 805- of.. (=o4 P1 IPL.I ah-k3"
New Electrical
Additional work to be performed under this permit— check all that apply:
_Mechanical _, Gas Tank _ Gas Piping _ Shutters _ VAndows/Doors — Pond
— Electric _ Plumbing —Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction:
Cost of Construction: $ 16, 58g, 00
Sq. R. of First Floor.
Utilities: _Sewer _Septic Building Height:
Name Ir
Address:
City: Tez lk C-55esz State:IP,
Zip Code: Fax:
Phone No.. L�Oo:
E-Mail: C4ssra.��do�c4�e. s� •�'�•�s
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Name:Ole"N;
Company: 5{ s-4-
Address: `i2-o t
City: All, State:�2
Zip Code: S"ILkO3 Fax:
Phone No 985- 2-1A t
E-Mail
State or County License_CGtc ( S2-4�+ 26
rr value of construction IS 25M or more, a rttwrrucu imumc vr wrrrrncncnmuni; is requirea.
If value of HAVC is $7,500 or more, 2 RECORDED Notice of Commencement is required.
WSMINEER: ` 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:
vvvimr-nl a.Ury I KAC, I UK 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 represent'on 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 wok
in accordance with the approved plans, the Florida Building Codes and St 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 lonrirr or an_attnrnev hpfnre cnmmencine work or recardina vour Notice of Commencement.
Signature of Owner essee/Contractor as Agent for Owner
rise older
STATE OF FLORIDA,
COUNTY OF`� I�
STATE OF FLOR
COUNTY OF i�'`-�`I`-���
Svv,6m to (or affirmed) and subscribed before me of
�..i by day Pres ce Online Notarization
, day of _ _�.�'g28-by
w m to (or affirmed) and subscribed before me of
P sisal Pres nce o[ Online N rization
this day of'CnnLS,� 202�by
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.C�l} l�O\oQI—wti'`
NaMe of person making sta mint.
Personally Known OR Produced Id ratification
4NWe of iden " n _ t , n
duced__
Name of person making statement.
Personally Known OR Produced identificatl
Type of Identl#qtIon
Produced
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2D salter
lisgTaMw bf ITO ry u IIc- public - State of Flo
Commission ® GG 93739
or : '
Commission N (J;lga�mm. Expires Dec S. 2
f S nature of Notary Publk-
OF FLORIDA
mission No. CPSM at 6786
,lati�
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DATE _.._
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COMPLETED
Rev. 516/20