HomeMy WebLinkAboutSara Krick_Panel_Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ] Q I g'2-k Permit Number:
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Commercial Residential
CBDG Funding
PERMIT APPLICATION FOR: G ( eC�r'D
PROPOSED IMPROVEMENT LOCATION:
Site Plan Name:
_ Block No.
Project Name: l- cw-c" Ck
DETAILED DESCRIPTION OF WORK:
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit -check all that apply:
_Mechanical —Gas Tank
Electric _ Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $
—Gas Piping _ Shutters _ Windows/Doors Pond
_ Sprinklers _ Generator _ Roof Pitch
Sq. Ft. of First Floor:
Utilities: —Sewer , Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name � ay i
Name: rl -}-�
Address: e;po 3 „ ten r� ,��� Lin
Company:
Address:_315 NP Gle
City: i State: F%-
Zip Code: 392IW3 Fax: —
Phone No Ali' - L+02'— Cie'I (1
City: _T70 r_4 'Pi e r e- _ _ State: —F
Zip Code: S SJe151_ Fax: --
Phone No. !1 7D - i d 9 - H Le 9 I E-
Mail: r5np-)j mnaicLo !' )" La
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail -} ' (
State or County License EC 13 O O 1 qI
-- - Y 11. ..1 wag ul 111w, c, a mrn-unuru mouce or 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 Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY: 'Not Applicable
Name:
Address:
City.
Zip: Phone:
V WIVtK/ GUN I KALI UK AFFIOVIT: 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 conflict 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 1 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 at;ermeyJbgfore cQn1wencine work or recordine your Notice of Commencement_
STATE OF FLORIDA
COUNTY OF
Sworn to (or affirmed) and subscribed before me of X Physical Presence or Online Notarization
this _9-day of (9c bat- 20 4 by
Name of person making statement.
Personally Known X OR Produced identification
Type of Identification Produced
(Signature of Notary Public- State of Florida )
Commission No. Ll5&5 ,� (Seal)
REVIEWS ' I FRONT I ZONING
COUNTER REVIEW
SAVANNA STILLWELL —
My COMMISSION # GG 197659
EXPIRES: March 19, 2022
Bonded Thru Notary Public Unrerwrilem
SUPERVISOR I PLANS VEGETATION I SEA REV RILE I MREV EWVE
REVIEW REVIEW REVIEWIEW