HomeMy WebLinkAboutChamis_ Permit ApplicationAll APPLICABLE I FO/a,M ST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: , Permit Number:
S 'iLL! cat
, 6, `� �' `" 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
Address:
Property Tax ID #: 3.5 J T —C.O01 ` — aco Lot No.
Site Plan Name: Of+- Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit —check all that apply:
_Mechanical _ Gas Tank —Gas Piping _ Shutters
Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction: Cost of Construction: $T/��
Generator
Sq. Ft. of First Floor:
Windows/Doors _ Pond
Roof Pitch
Utilities: _ Sewer _ Septic Building Height:
OWNER/ SSEE•
CONTRACTOR:
Name / ti (
Name:_
i
Address: RZD d:0600,0r. 1
Company: ef"
atn /
City: ` State: J±_
de Zip Co: 3�{�S'7 Fax:
Phone No.QC��- / �— 'J`l
E-Mail:
Address:
City: �a
Zip Code: 3 Q"i Fax:
Phone No . —
State:
690—��
U
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail
aa17t
State or County Licens (!�lk — Q33-j
%
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.
Name.—LIWE
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDEP_ Not Applicable -
Name,
Address: --
City:
Zip: Phone: - - -
MORTGAGE COMP Y: _ Not Applicable
Name: Il%/ f►
Address:
City: State:
Zip' Phone:
BONDING•COMPANY: Not Applicable
Name:
Address'
City:
Zip: Phone: —
OWNER/ CaNT€tAtTf1R AFFtDW cWon 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 two representation ttwai is grmiting a permit will authorize the permit holder to build the subject structure
which is in conflict with- arty applicable Hem Owners Association rules, bylaws orania covenants that may restrict or prohibit such
structure. Please consultwsth your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested perms) do hereby agree that I will; in all respects, perform the work
in accordance with the approved plans, the Eloricla Building Codes and St. Lucre County Amendments.
The following building permit apoicatkm we iLmPrnpt from undergoing a fall concurrency review: room additions,
accessory structures, swinm»it , fernsk :iiitatls, sighs, screen rooms and accesswf usesto another non-residential use
"WAR MW TOO YO�t FAQ lWM.TO 1 A OF MAY FSSMT W YOUR PAYING
TWV.E FOR S TO Yam PR011ow". A NGTXX OF MUST BE RECORDEQ AND
POSTED ON TM JOS SITE BOOM TW FAST .N. IF YOU !i'FEW TO OBTAN I MANCWG, CONSULT
611"lrilUR: LERIMORANATrQMWMWSMFAXDRDMYOMNDTKEOIF ."
zt
Signature of Owner/
Signature of Contractor/License Holder
FLORIDASTATE OF �-�, : �. � �_ I COLlI!M OF
STATE OF FLORIDA
COUNTY OF act
The fo instrumentwas acknowledged tefore me
this day UtfrV
- 24� by
!
lollO,-,
Name of person making statement.
Personally Known �—OR Produced Identification
Type of Identification
Produced
ALL
(Signatur of Nota; tc=State of Taft j
REVIEWS
DATE
RECEIVED
The fo tie instrt�mi? was acknowledged before me
this day of _/�� 20_21 by
Kim 1iSow
Name of person making statement.
Personally Known OR. Produced Identification
Type of Identification
Produced
(Sigr5tum cf l Public- State of I
boom
Commission
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