HomeMy WebLinkAboutHicks changeout finalAl! APPUCABLE INFO M ST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Fate: Permit umber-
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Planning and DevelopmentServices
Building and Code Regu{etron Division Commercial
300 Virginia Avenue, Fart Pierce FL 34,982
Phone: (77 ) 46 -1 5 Fax: (Z) 4 -157
PERMIT APPLICATION FOR:
:
PROPOSED IMPROVEMENT LOCATION:
Address:
Property Tax ID u
Site Plan ame-
Project Name:
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed
X'Norlechanicaf Gas Tank
Electric T Plumbing
under this permit — check all that apply:
Total Sq. Ft of Construction.
Cyst ofConstruction.-
2— ��(")
OWN E/LESSEE:
Barrie
_( (W
Address:
City:
Zip Code: '
Phone No.
E-Mail: IAA 4
Fill in fee simple Title Holder on
from the Owner listed above)
r�w
Gas Piping
Sprinklers
Building Permit Application
Residential
[.1
Block No.
_ Shutters Windows/Doors Pond
Generator Roof
q. Ft. of First Floor:
Utilities: Sewer _ Septic Building Height:
tate:T�.
page ( if different
CONTRACTOR_
Name -
'Company,
Address:
City:
Zip Code:
Phone No_
ER11'ial#
State or C(
P)Ly L.,%.-_PJ.), q_-
If value of construction is 2SOO 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.
Pitch
Stater
SUPPLEMENTAL CONSTRUCTION LIES{ LAB! INFORMATION:
iEIiE
Name: —
Address:
City:
iP;
ENGINEER:
Not Applicable
State: ---
Phone ---
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: Not Applicable
Name:
Addre- ss=
City: State:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name: _
Address:
city:
Zip: Phone:
OWNER CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
l certify that no work or installation has commenced prior to the issuance of a permit.
t. Lucie County makes no representation that isranting 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 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. roorn additions,
accessory structures, swimming pools, fences, walisF signs, screen rooms and accessory uses to another non-residential use
WARNING ToOWNER: Your failure to Record a [notice of Commencement may result in Raying 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 recording your Notice of Commencement.
i!4Aure �f 0 w nerf `- ss /Contractor a-s Agent for Owner
STATE OF FL#RIQA. COUNTY OF
���
wo o (or affirmed) and subscribed before me of
fj)Vicall Presence o nline Notarization
this day of 2020 by
Narhe of person making statement.
Personally Known OR Produced Identification
Type of Identification' ,
ProcLmed
ignat� of (3ontr ttor License older
STATE OF FLORID yr I q
COUNTY OF
w to for affirmed) and subscribed before me of
P sical Presen e r -Onfine Notarization
this day of 2020 by
--- n i ^ 1 r C�l _ A ^ A
Name of person making statement.
Personally Known OR Produced Identification
Type of ldenti#icati n
Produced
V"t r 1 Y p ' `f �� ( f n L� I L r
Notary public - State of Florida =i
rnmiommission :y-,. �ion �GG ew# Commission No. = �
f f - my Comm. Expires May 16, Z023
OF
Bonded through National Notary Assn. "
REVIEWS FRONT ZONING SUPERVISOR PLAINS VEGETATION
UNTER REVIEW RE IEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED I 1
e.
d � V i n l 4 BAKER
- Notary Pub]ir- -State V Roride
Fi ✓ 'f Comm. Exrir;5 May 16. 2OZ3
e,anded through National Notary Asso-
SEATURFLE MANGROVE
REVIEW REVIEW