HomeMy WebLinkAboutBuilding Permit App - 1998 shinn rdAll 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, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: I Q q 8 S 1
O
Property Tax ID #: Oc3 I O — Ua.3 t7� 1 - O 17c> ` p
Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
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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 _ Windows/Doors _ Pond
_Electric _Plumbing _Sprinklers _Generator Roof !;Fj J0 Pitch
Total Sq. Ft of Construction: Za s 3 Sq. Ft. of First Floor:
Cost of Construction: $ ai7, O o o Utilities: _ Sewer _ Septic Building Height:
OWNERAL SSEE:
CONTRACTOR:
Name ijejl
Name: SIG
a O
Addres A d.
Company:T GcC, -
00
City: OP+ PiLCW Stater,
. Address: / 6 t„r r 1
Zip Code:3q qa l 5 Fax:
City: 1 1, .uU 2 Stater
Phone No. 77vL- q3- 8219/
Zip Code:36%� Fax:
E-Mail:
Phone No % O -9 % '76
Fill in fee simple Title Holder on next page( If different
from the Owner listed above)
E-Mail T ' 2 ZL
State or County License
If value of construction is 2SW or more, a RECORDED Notice of Commencement is required.
H value of HAVC Is $7,500 or more, a RECORDED Notice of Commencement Is required.
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DESIGNER ENGINEER: T Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: _ City: State:
Zip: Phone Zip: Phone:
I
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: _Not Applicable
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.
1 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 is in can 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 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 attorne before commencin work or recordinR your Notice of Commencement.
1
Signature of Zlwner/ L e ontractor as Agent for Owner Signature ofCol.r!96ir/L&Ke Holder
STATE OF FLO!!�rSTATE OF FLORIDA /
COUNTYOF c;,_ 5-i•• [.•cICJC
COUNTY OF
Sworn to for affirmed) and subscribed before m of Sweern to (or affirmed) and subscribed before me
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sical Presence or Online Notariz t —@hysical Presence or online Notarizat rl��J
Ida,
this of 2020 by this -t- day of a 2++0 0 by
1 ��w �� "L��� C)n°Z
. Nameo person making statement. p. �. Name of person making statement. 3 3'z 1
Personally Known --< OR Produced Identifi Personally Known *4'� OR Produced Identifica rm w QQ�
Type of Identification z x N Type of Identification z-'
Produced o a. m m Produced 0.8 N a
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(Signature of Notary Public- State of rida) N N n (Signature of Notary Public- Statef Florida) N N o
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I Commission N� VQJ-L (Seal) rN.� Commission No ,a alto- (Seal)
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REVIEWS FRONT ZONING j SUPERVISOR PLANS VEGETATION SEA TURTtE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.