HomeMy WebLinkAboutPERMIT 1321 LONE PINE DRAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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° c ra - Building Permit Application
Planning and Development services
Building and Code Regulation Division Commercial Residential itk
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
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PROPOSED IMPROVEMENT LOCATION:
Address: 1.3a( Lo!i ne- �r
Property Tax ID#: 34a9- SOS- DOaiq- OHO' Lot No, 1`!
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
d-00S and 0ngiP-rJCj m !
New Electrical Meter Second Electrical Meter
[CONSTRUCTION INFORMATION:
Additional work to he performed under this permit -check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors _ Pond
Electric _ Plumbing _ Sprinklers _ Generator _A Roof $�/J Pitch
Total Sq. Ft of Construction: .r O 90 Sq. Ft. of First Floor:
Cost of Construction: $ 6o 000 Utilities: -Sewer Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name 5(150,4 pr Name: n
Address: /3a./ 6on OV. Company: %l�44Cil.S Cep dp y'
City: Or N'/�Q�GG State: %G Address: / 5rw
Zip Code: Vi R.1 Fax: City: Orr ,$' , State: FL
Phone No. Zip Code: Fax:
E-Mail: Phone Noo - 91770
Fill in fee simple Title Holder on next page I if different E-Mail T ' ' G '/A
from the Owner listed above) State or County License CCU'/ 346S
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.
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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: Applicable
_Not
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 Countyy makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in contlict 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 5t. 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-residentlal use
WARNING TO OWNER: Yourfailure 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. It you intend to obtain financing, consult
with lender or an attorneybefore commencin work or recording our Notice of Commencement.
Signature ofOwner/&p*/C&RFactor Agent g per
Signature of Cont ctor cen erg
STATE OF FLORIDq
STATE OF FLORI
COUNTY OF f ; Q,
COUNTY OF &CWL
Sworn to (or affirmed) and subscribed bef r
Sworn to (or affirmed) and subscribed befor
me i
k Physical Presence or Online N to z
thisTS-dayof .�i-tAE— ,202
Ph icaI Presence or Online Not
thisdayof .5�+� 2020
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Name of person making statement.
Name of person making statement
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Personally Known .h OR Produced Id tii �,l
Personally Known OR Produced Ide
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i Type of Identification
Type of Identification
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Produced
Produced
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(Signature of Notary PX@OState of Flori
(Signature of Notary Publ - to of Florid
Commission No. �C7� �d' (Seal)
Commission No. AI97Y3? - (Seal)
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