HomeMy WebLinkAboutSlavsky Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
v
�P a'Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential KI
2300 Virginia Avenue, Fort Pierce F! 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
AS14P_ 6-u.e<i . C�13�A _/<_�wcJW - S",ee
New Electrical Meter Second Electrical Meter
(Affidavit required)
Additional work to be performed under this permit— check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors _ Pond
,` Electric k Plumbing _ Sprinklers
_ Generator _ Roof Pitch
Total Sq. Ft of Construction: D C �a(Q t1�S �'��+� Sq. Ft. of First Floor:
Cost of Construction: $ % 4, `7$0—' Utilities: _ Sewer _ Septic Building Height:
Name Jolt -k CQ%?0I S S
Address: 4 % LO Q JP i vie W001 ; -�—
City.,WOo ;P i S Stater
Zip Code:`% 30 2- Fax:
Phone No.
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: -E-b - le., �o
Company: WIK �S 31 +441 a
Address: bl 1 Rr ,oGPAL
City: Z�11w%A Z-V State:t I
Zip Code: '0 % Fax:7_j;A--246 ";207'�2--
Phone No -Z-5_
E-Mail 4vf PA 'S ,.Ia , to
State or County Licensee6-C /30-7979 1 Z,,2 32Q
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.
aUPPr% c{ar-rl i i/{►�nrci:
DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY: e
Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
BONDING COMPANY: to 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.
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.
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF AA ta` rJ
Sworn tR (or affirm#1 a7d subscribed before me of Physical Presence or Online Notarization
this ay of ,AtA[ , 201) by
Cts Gat 3 -e1i
Name of person making statement.
Personally Known V OR Produced Identification
Type of Identification Pro u
A
(Signature of Notary Public- State of Florida
«YP DAVE D. MORELLI
Commission No. (Se Commission # HH 110877
g. Expires May 8, 2025
''AFOF F4�a'• Bonded T}ru Troy fain Insurance 800.385-7019
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DATE
RECEIVED
DATE
COMPLETED
ev/20/21