HomeMy WebLinkAbout9636 CROOKED STICK LN, PSL, FL. 34986 SLC PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ` G a0Permit Number:
(M
O
t3 c c C" 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: nc� e L yeQe �cDk�4e.. _
PROPOSED IMPROVEMENT LOCATION:
Address:
Property Tax ID #: 5321 - 1 - OU i Lot No.� _
Site Plan Name: POO IT at fh[ Pub L Cffi LIC-10 Loi 3(C;9 111! 1- T 15) Block No.
Project Name: Hp k C
DETAILED DESCRIPTION OF WORK: S; ►n to L; rc (&v-aOe-
New Electrical Meter Y Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit- check all that apply:
_Mechanical
Electric
Gas Tank
Plumbing
Total Sq. Ft of Construction:
_ Gas Piping
Cost of Construction: $'�il�
OWNER/LESSEE-
Sprinklers
Shutters
Windows/Doors _ Pond
Generator Roof Pitch
Sq. Ft. of First Floor:
Utilities: —Sewer _Septic
Name Vs 1
Address:Q
City: Poci Si, State:
Zip Code: ?C/CIF6 Fax: 1\)P
Phone No. CA 11 — 3 - 59LA
E-Mail: r+r�� a �fcxv��Cli
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
CONTRACTOR:
Name: M p T T
Building Height:
Companyj2k�iftIrl
Address: 1
City: Stater
Zip Code: 38gSo Fax: 2-V 1
Phone No - Rlf
E-Mail _ .I� a�1L1 L
State or County License r -C
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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: �L Not Applicable
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: Not Applicable
Name,
Address:
City:
Zip. Phone:
MORTGAGE COMPANY: 7X- Not Applicable
Name:
Address:
City: State:
Zip: — Phone:
BONDING COMPANY: Not Applicable
Name.
Address:
City:
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 County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
structure. Pleasle consult w with your Home Owners Assoc ation and review your deed for any restrict that
which maor
aplprohibit such
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 tender or an attorney before commencing work or recording our Notice of Cornmencement._.
Signature of Owner/ Lessee/Contractor as ge er
STATE OF FLORID
COUNTY OF u Lt G
S%rrn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
This day of 'A'ILI 2021 by
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
produced
0 y�
( ,!A)A;- 7!11 L
Signature of ContractorJLicense Molder
STATE OF FLORIDA , u u
COUNTY OF Sf
SW7 to (or affirmed) and subscribed before me of
J Physical Presence or Online Notarization
this _4__. day of CG C-.ff" to 2020 by
NIN'TT i�c[C
Name of person making
statement.
Personally Known OR Produced Identification
Type of Identification
Produced
-ML
(Signet u [ (Signatif o r P b EJANEMCCAULEY
J
{ Y'� ..
Notary Public - State of Florida : i►* u JULCommission 1 HH 4487k6eal Commis ¢= N al)
Cornmisslm pares Oct 1, 024 �" ComY My Com1
Bonded through National Notary Assn. ---�
_im ded th,vuf
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
ETA
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW i
DATE — — -
RECEIVED '
DATE -----
COMPLETED