HomeMy WebLinkAboutBysshe Permit AppAll APPLICABLE I FO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
`. Ur 0El
c L- 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:
Property Tax K
Site Plan NamE
Project Name:
DETAILED DESCRIPTION OF WORK: I
s4a-0 aoo 76TL) Ri per.
New Electrical Meter Second Electrical Meter
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: 44d Sq. Ft. of First Floor: 312-0
Cost of Construction: $ g202 - Utilities: —Sewer _ Septic Building Height:
OWN ER/LESSEE:
CONTRACTOR:
Name I O /+�
Address: IyW O1 N&X(\ARr5- c..�Ce k- JU.
Name: - Pcle.!` � e1
Company: MtllefS T_
City: TO -Irk ____ State: R.•
Zip Code: 3 `') 4 I a Fax:
Phone No. 772-336 - 13(o``(6
Address: fJ Q R t(- Ve.
City:?QC-T ST• L�ccc_i State: rL-•
Zip Code: 3y91�13 Fax:
Phone No is� 0
E-Mail: r- bt4 •5�ke_ (2Qb� . CcCti
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail a"G'@_ W, i le-S_U.A }(� G� (.cps
State or County License GAC_0 bb71
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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: Not Applicable
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.
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 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: 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 recording our Notice of Commencement.
Sign�f Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF �T� Lk�—1
STATE OF FLORIDA
Lckca e.-
j
COUNTY OF
Sworn to (or affirmed) and subscribed before me of
S(�o,rn to (or affirmed) and subscribed before me
of
Physical Presence or Online Notarization
7�Physical Presence or Online Notarization
this a day of i 2020 by
this 5 day of !Ct 2020 by
Fred eAI de �-!� Il-�
Fhe I,er
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known el< OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
R'.",
N
(Signet r of Notary Public- State of Florida
'9D„N"N��
(Signat e of Notary Public- State of Florida)
Commission No. I23 e)2 (Se
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Commission No. 12_31 2 , (Sea
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