HomeMy WebLinkAboutPermit App Knapp pg 2All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:.&6, Z r2,o2_4 Permit Number:
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 CBDG Funding
PERMIT APPLICATION FOR: , wMa5m '
PROPOSED IMPROVEMENT LOCATION:
Address: 2_� 0 W A �T—
Property Tax lD #: 3Lu q ``) (5= 02_&?' 0a6 -'. Lot No. I
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
New Electrical Meter Second Electrical Meter
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 Constructions
Cost of Construction: $ 3SQ- Qeoz)
(Affidavit required)
_ Generator
Sq. Ft. of First Floor:
_ Windows/Doors _ Pond
_ Roof Pitch
Utilities: Sewer —Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
ee
Name (f / - +fPP
Name:
Address: 2J0W 1"- _
City: j Ct6_ State: f`L.-
,l Zip Code: 9 s--z_ �iFax: c
Phone No._112 -- d p A �� 6�i E-
Mail:
Company: AAV7 G % A7J
Address: s
Cr_�177_
City: 0i' � u".6 State: 7�--
Zip Code: �q`56% Fax:
Phone No -7-72-, 336 �� d
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-mail 0-r'(_e_e_bree'Z.e_-
State or County License 64CJ9'0z-7�f
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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
Name:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
BONDING COMPANY: Not Applicable
Name:
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 conflicts with any, applicable Homeowners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Homeowners 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 attornev before commencing; work or recording your Notice of Commencement.
ignatu of Owner/ Lessee/Contractor as Agent for Owner
E OF FL A g
COUNTY OF _ kY I UCC e
Sworn to (or affir ed) and subscribed before l� me of I1ysical Presence or Online Notarization
thiday of 2 by
Tame of person making statement.
Personally Known OR Produced Identification 6-
Type of Identification Produ ed� 0 e r i _.1 C 0 y')
(SigriAure ot Notary Public State o orida)
v f t>F MICHEL LE GREEN
G c3 (Seal)
Commission No. (� c� Seal y :;_ �,�,, �;��_ Notary Public - State of Florida
yF Commission # GG 286318
c Fr1 My Comm Expires Dec 2.0, 2022
Bonded through National Notary Assn. _
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