HomeMy WebLinkAboutPORTIK PERMIT APPAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ()9 - I3 -a.0a1 Permit Number:
uaLL
° ° ' 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: C n Q tJl�-V
PROPOSED,IMR:ROUEIVIENT•L'OCATION
Address: �J� ,c W
3�Ja�' 1- ��%ai7 - a Lot No. 3
PropertyTax ID ff:
rP O R I�� y Block No.
Site Plan Name:`
Project Name:
ni d
DETAILEb;DESGRtIPTION OFWORK
no k00\A,
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:;; P- ,
Additional work to be performed under this permit- check all that apply:
XMechanical _Gas Tank _Gas Piping _Shutters —Windows/Doors _Pond
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft, of First Floor:
Cost of Construction: $'5(�M Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE':
GONTR'ACTOR
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Name:
Name
Address: 1 �[-a Cl
Compa C� Ir Q�� �\ Or\ky�
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Address:5YI t\ u) vlerc ✓1 61 a V \
CityC.t L State:-�L
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Stater
Zip Code: Fax:
city: nti to
Phone No. —n a L- jffi "LFL�s E-
Zip Cade::2 {4gEKO Fax:
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Phone No Z1 r(6)
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E-Mail v'Nt � Gd 0.�r t��
Fill In fee simple Title Holder on next page (if different
l AC � 6 i QA HA
from the Owner listed above)
State or County License
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.
SUP, LfMENTALCONSTRUCTION
IIEN OW IIVFgRMPTION
DESIGNER/ENGINEER:
_ Not Applicable
MORTGAGE COMPANY:
Not Applicable
Name: 1J R
Name: til A
_
Address:
Address:
City:
State: _
City:
State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLEHOLDER:
Not Applicable
BONDING COMPANY:
_Not Applicable
Name: N
_
Name: NA
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 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, 1 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
,.,Irh lonrler nr nn nttnmpv hafnrp rnmmencine work or recordine vour Notice of Commencement..
Signature of Ov 11er/ Lessee/Contractor as AgenNyl Owner
STATE O FLORIDA
COUNTYOF
Sworn to (or affirmed) and subscribed before me of L Physical Presence or _ Online Notarization
this A�k_ day of Semi Paysk�e r20o2L by
UTA I -s �e,L ,
Name of person making statement.
Personally Known X OR Produced Identification
Type of Identification Produced
(Signature of Notary Public -State of FloridLFTrida MILLER
/� ^���'7-Notary Public
Commission No.l� QQD l % {heal) N GG 202177
[;�=&wte
ssion Expires
1, 2022
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