HomeMy WebLinkAboutHelseth Permit App 7805 14MAY2021ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: q805 rmmot(01,06E RD feitz-1-W pl,51iae FL
anal Dascrintion: t96E A77AC1HC.Wp PROPek-ly dh9RD
E2 7
Property Tax I D #: I 3 % J17 — I.2 I — 000 / � zoo) 00 ' / Lot No.
Site Plan Name: Block No,.
Project Name:
Setbacks front Back: Right Side: Left Side;
DETAILED DESCRIPTION OF WORK:
R5PLACE RUSTE10 E�.ECT&lCooPtL MEFTGR t 1 sER. lGiti nti� A 200aMP
6r1Ntc-t.,z POASE 3ACK To DRe►< 5ERVtCFj
CONSTRUCTION INFORMATION:
un erthis check a
Gas Piping
---,1Spr*1nklers
Additionat-W"ork to be performed
DHVAC � Gas Tank
Electric ❑ Plumbing
Total Sq. Ft of Construction:
as
Cost of Construction: $ � �
OWNER/LESSEE:
N a m e H & 1%,, 0 I= I H r1 UL-J11UtT3 1..,I%t m
13at apply:
Shutters
❑ Generator
S . Ft. of First Floor:
Utilities: Sewer 1:1 Septic
Address: A16 ,Q/M!N 1 L)R
City: FOR7 PIERCE _State: -FL
Zip Code: J!1914 Fax:
Phone No. r77 i_o � 1308
E-Mail: gri Ct.l? N2Ise, TA-( -
VQ,0. e.."o M
Fill in
fee
simple
Title Holder on next page ( if different
from
the
Owner
listed above)
Windows/Doors
❑ Roof
Building Height:
Roof pitch
CONTRACTOR:
Name: %' NA R i. E__,S W E
company: ONAR LES koailE F Lta:_ CTR I C J�w C.
Address: yEglymv DO ST*JOF APT. A
City: FdRT 19RCE State: FL
zip Code: Fax:
Phone No(1772 332- g��8
E-Mail: ekovieElec IcTnC (,01 Q• CD!►�
state or county license: *4 ei l
ERAtp DO / JArl
if value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL-CON,STRUCTION'llEN LAW INFORMATION:
DESIGNERI 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.
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 a!1 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 accessary uses to another non-residential use
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in your paying twice for
improvements to your properly. A Notice of Commencement must be recorded 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 recording our Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY Of c
The forgoing instrument was acknowled d
this day of (1liQl� , 20�
Rev. 8/2/17
before me
by
ignature of Contra ctor/Li cen se Holder
STATE OF FLORIDA
COUNTY OF �St I IA C1
The forgoing instrument was acknowleded before me
this
day of
202-1
by