HomeMy WebLinkAboutMike Novak Permit AppAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
> �L��_�'U'!D�0 �tt 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: '�h�,�'r
PROPOSED IMPROVEMENT LOCATION:
Address: C29_I c-D,2 � rQSt �E R
Property Tax ID #: LA 1"5 O 5 00 \ B Lot No.
Site Plan Name: �Aichaf- J. NI0\IGIY__ Block No.
Project Name: "� C CL-P 1 1Q0
I DETAILED DESCRIPTION OF WORK: I
New Electrical Meter Second Electrical Meter
j CONSTRUCTION INFORMATION: 1
Additional work to be performed under this permit- check all
/that apply:
_Mechanical _ Gas Tank _ Gas Piping X Shutters
_ Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ 13'�5C0
Generator
_ Windows/Doors _ Pond
Sq. Ft. of First Floor:
Roof Pitch
Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name�A ale k N0VGY_1'
Address:10LoD, k-MS-V ' 1 E
Name: CtV1ntAC\ 7rA?i
Company:,USt�-}-
City:p`C-V uCAC State: �1
Zip Code:aAgtrD2 Fax:
Phone No. c 50�.� 3�j0,
E-Mail�� (,'`���pK Q Qc)t-CL40
Address: \'S NV�,I F'r�or�Se O
Cit;..-p Sfi 1,� �- State:
Zip Code: g �P Fax:
Phone No _1.1 3�, G(Ol Qq Ia
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail LsS c fi
State or County License
IT value or construction is [SUU 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
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.
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 a4ld posted on the jobsite before the first inspection. If you intend to obtain financing, consult
with lender an attorney before commencing work or recording our Notice of Commencement.
Signature of wner/ Lesse Contra or as Agent for Owner
Signature of Contractor/License Ho der
STATE O FLORID
STATE
COUNTY OF >> VC�2
COUNTOY OFRIDA �t— LyC�
S�o (or affirmed) and subscribed before me of
P Presence Online Notarization
Sworn o (or affirmed) and subscribed before me of
�ysical
ysical or
Presence or Online Notarization
this day of 2020 by
this day of 2020 by
S(�VV v'
Name of person making statement.
Name of person making statement.
Perso Produced Identification
Personally OR Produced Identification
Typ of
Type of I entification
Pr ce
M
Produce
(Signature of Notary Public- State of Florida)
(Signature of Notary Public- State of Florida )
(� >s+Y Pua gLYSSA A.T. BOWSER
Commission No.a� 1 ..,+ `, 5 ssion# GG 295930
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A YSS,j A.T. BOWSER
Commission No. ' ,> ' %0on
' Expires January 28, 2023
E BoraaarnrueudgetNotary Services
4 C� # GG 295930
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