HomeMy WebLinkAbout232 permit_applicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 20 1 Permit Number:
-
IL' 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:
Address:`'Dr ;,-f. At ; o'i yi� -rc Ila
Property Tax ID #: 14 As� T Q —00te r oe ' 0 Lot No.
Block No.
Site Plan Name:
Project Name:
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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 iVlndows/Doors _ Pond
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_ Electric _ Plumbing _ Sprinklers _ Generator Roof Pitch
Total Sq. Ft of Construction:r`��`/ Sq. Ft. of First Flaor. `5y1j%_�_
Cost of Construction: $ Utilities: _ Sewer _ Septic Building Height:
gt .3- !"
- - - - -
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Name 11
Name:
Address;)3a, T Mtge, !&Ae4.. detvt—
Company: 9 W
City: d''" iG +'s1S-03& 1:5I'ON.t- State:
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Address: $11A 01�
City: S tr LAB'' state:_jK
p ' `�� Fax:
Zi Code:
Phone No. � f - Le r5 KY,
Zip Code: �q � Fax:
Phone No
E-Mail: O.V1U ' AkWk
Fill in fee simp a Title Holder on next page ( if different
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State or County License ('11 or4 63
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from the Owner listed above)
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.
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
is in applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
which conflict with any
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 commencingwork or recordingour Notice of Commencement.
W4 - 4&k.,
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF
Sworn to to (or affirmed and subscribed before me of sical Presence or Online Notarization
this day of 20V by
Name of person making statement.
p g
Personally Known / OR Produced Identification
Type of IdentiftCation Produced
(Signature of Notar P I" - Sta Florida) 001011 Notary Public State of Florida
/ Timothy J Kozlowski
Commission No.% (Seal) � MyCommis_WGG1941585
'h pf �d Expire$, 0311112022
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