HomeMy WebLinkAboutPeterGiffenPermitPackAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fart Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR: �—` ;
on
PROPOSED IMPROVEMENT LOCATION: 1
Address: Q
Property Tax ID #: G I _ — Lot No.
Site Plan Name: a7z• ;► kamnnoc h g IBC 1 Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
New Electrical Meter -----Second Electrical Meter
CONSTRUCTION INFORMATION:
3� j' Ind GCh
(Affidavit required)
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 Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 1 `oo - Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
Name:
Address: , i'aa w �AGmmk i
Company:
City: F-A: • e1 State: (,
Zip Code: 34gg ( Fax:
Phone N . c) , — (p E-
Address:l,
City: Statei�L
Zip CoAe.Fax:
PhoneFill
Mail:
in fee simple Ti le Holder on next page (if different
from the Owner listed above)
E-Mail
State
-. • ...••��.+....+�� •� �w v� uw•c, a n—unucu avouce yr Lornmencement is requlrea.
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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: Applicable
Name:
_Not
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
V YU fYCIR1 1-UM KHL I UK Ail-HU V II I: 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 com encinp work or recordin our N ti f C
o Ice o ommencement.
Signature of Owner/ L ssee/Contractor as Ag for Owner
STATE OF FLORIDA
COUNTY OF [�r:
Sworn to (or affirmed) and subscribed before me of v Physical Presence or Online Notarization
this Z0+hday of 20?,l, by
rqynam �d+L
Name of person makingstatement.
/
Personally Knowny OR Produced Identification
Type of Identification Produced
GO A4,6,
\����� �•I �.
(Signature of Notary Public- State
Commission No. � "] �ea . n:
IJ ia..A A % ?C� R
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