HomeMy WebLinkAboutslper2All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date
Permit Number:
LL Ur Cur
> L c a e c, L� 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:
PROPOSED IM`PROVEMElU LOCATION:
Address: tKZ% WIV "nl6o/ cle- — — -
Property Tax ID #: �K26- 502,` 0013--0-0 Lot No.
Site Plan Name: Block No.
Project Name:
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
(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:
Cost of Construction: $
Sq. Ft. of First Floor:
Utilities: —Sewer _Septic Building Height:
OWNERf [wESSEE:
CONTRACTOR:
Name JoSeeA fQ Z✓v/Y))'tPr/'
Name. 'ys 6a/gs'P
Address: C gZ% RAV ✓3tl[Y`drt16r/S� Gf
Company: L `i�<< 6g�Tz 6K- 6 C 3gcS W
City: 6(-0 Cc7`S� State: f .
Zip Code: 3`(CiQ(, Fax:
Phone No. E-
Address: (T ` of �F S�
City: �;ryg/"r" State: eC-
Zip Code: 3!(?f6 Fax:
Phone No &70 63[ -6 2,60
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail ` �5�i✓�i�S •`,✓
State or County License 905
IT value or construction is zsuu or more, a xtwKutu 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 ApplicableI MORTGAGE COMPANY: Not Applicable
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:
Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
Not Applicable
UINNCK/ CUN 1 KACTUR 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, wails, 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 attorrie*before commencing ►Arnrk nr rPrnrrlinu vnrir Ain+iro of
Sign u ner/ esse n actor as Agent for Owner
ST E OF FLORIDA
COUNTY OF MAY\1()
Sworn to for
affir ed) and subscribed before me of V Physical Presence or Online Notarization
this l 9iay �
of —� 20_Q� by
Name of person making statement.
/
Personally Known OR PErduced Identification V
ation oduced H JUL
Ty K:Z),
(Signature of Notary P blic- State of Florida)
Commission No.(Seal)
Jti�eYn�;'... SUSAN.AAAWORSKI
c.
Notary Public State of Florida
V. Commission N HH 113768
c F`a>Q,' My Comm. Expires Apr 13, 2025
Bonded through National Notary Assn.
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