HomeMy WebLinkAboutHoward, Betty permit appAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: - � Permit Number:
L' I'C�llL
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial
2300 Virginia Avenue, Fort Pierce FL 34982 Residential
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: � - —
PROPOSED IMPROVEMENT LOCATION:
Address: RR' n 1-PZ�-� 11-4
Property Tax ID #: � �- 1 - w3Y _ nn0
Lot No.
Site Plan Name: � � +�'_. i"1� r1.�1�.����-, �
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 Construction:
Cost of Construction:
$ _(P,1 CX�
OWNER/LESSEE:
(Affidavit required)
Windows/Doors
_ Generator Roof
Sq. Ft. of First Floor:
Utilities: —Sewer _Septic
Name 3 r--! Y at) W 4-11L-0
Address: 92 O L V O
City: SF 4 FN oc If- State: rL
Zip Code: 3gSs, Fax:
Phone No. ((g,
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
CONTRACTOR:
Block No.
Building Height:
Pond
Pitch
Name:
Company fl '
Address: C( S &;k (rl 6 .
City: �- [ U State:
Zip Code: Fax: 2 (V
Phone No C3
E-Mail .PJ
State or County License_ k f -1,
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: Y Not Applicable
Name: MORTGAGE COMPANY: D� Not Applicable
Address: Name:
City: Address:
State: City:
Zip: Phone State:
Zip: _ phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY:
Name: Not Applicable
Address: Name:
City: Address:
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 noywork or installation has commenced prior to the issuance of a permit.
which is inocontlict with any applicable'Ho eaOwners Associnting a ation rwill
es,abylaws or the
dpcovenants that build
drestrictbor subject
bit suc
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply. h
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 your Notice of Commencement.
n
Signature o Owner/ Lessee/Contractor as Agent for Owner
STATE O LORIDA
COUNTY F_ r�o
Sworn to (or affirmed) and subscribed before me of
this � day of
v
20�1 b Physical Presence or Online Notarization
Name of person making stateme t,
Personal) OR Produced Identification
Ty dentification rodurad
(SignaTure of Notary Public- State of Florida )
Commission No. �% // (Seal)
REVIEWS FRONT I ZONING
COUNTER REVIEW
DATE
RECEIVED
DATE
COMPLETED
>p� V °KONNI LENAE DE ITT
Notary Public - State of Florida
Commission 4 HH 165134
My Comm. Expires Dec 10, 2025
Bonded through National Notary Assn.
SUPERVISOR PLANS VEGETATION
REVIEW REVIEW REVIEW
SEA TURTLE I MANGROVE
REVIEW REVIEW