HomeMy WebLinkAboutmerson permitAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
°f' M 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
I PERMIT APPLICATION FOR: ke �C)G-p I
PROPOSED IMPROVEMENT LOCATION: y
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Site Plan Name
Project Name:
DETAILED DESCRIPTION OF WORK:
New Electrical Meter Second Electrical
CONSTRUCTION MFORMATION:
(Affidavit required)
Lot No. 1
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 t— 14�+tch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
1=qcto
Cost of Construction: $ Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE:
CONTRACTO
Name IeVCMQ 'I V KAMC41NIName.
Company: V
Address: ZQ
Address:
ror=,
City: State:
Zip Code: _ L Fax:
Phone No.
City: ,Q 6 State:
Zip Code: Fax:
Phone No
E-Mail(a Chi el
State or County LicensedliH&I U 19f 744
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
. rmuc vti6v114u UU% W11 a 4wv v1 illVLC, a Rwwrtucu woiice or commencement is requireo.
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 and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
with lender or an attorniev before commencing work or recordin our Notice of Commencement.
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Signature of Owner Lessee/Contractor as Agent for Owner
STATE OF ,
COUNTYOFORIDA �-r wC
Swo (or affirmed) and subscribed be o e me of Physical Presence or Online Notarization
this � day of /I 20LJ by
Yd tA-�
Name of person making stateme .
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Personally Known OR Produced Identification
Type tifi a ion roduced
(S nat a tary ublic a of Florida )
HAVENS#GG165030
Commission No. (Seal) 94M
04, 2021State
Insurance
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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