HomeMy WebLinkAboutSand Dollar Shores Building D Permit ApplicationAll APPLICABLE INFO MUST 13E COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
n, Building Permit Application
Planning and Development services
Building and Code Regulation DivisionCommercial Residential
2300 VIrgtnta Avenue, Fort Pierce EL 34.9492
Phone: (772) 462-1553 Fax: (772) 452-1578
PERMIT APPLICATION FOR:
q
Property / - -
Site Plan Name;
te
New Electrical Meter Second Electrical Meter, (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:
0
Cost of Construction: S ao... ®J ..." _ Utilities* _Sewer _ Septic Building Height:
�..;.+:...-.r:,;,a.•�..,..Y.�.,,_,.I ,. .. .. _. ... ... ........,..�1�'tY'''1'A�`'1*1�'�1'1'�t"��'1"13"1Q ,.. ,...:...,v>:;;',�.. ......,.,,,. L.,.. ..,
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City: i 1r n�� ra ,o _ State;l� �
Zip Code: 44?7 Fax:
Phone No. ~? d - !1- L352
Fill In fee simple Title Holder on next pages ( If different
from the Qwner listed above)
City: Ak-D;�Qa4 ? .U_Q C6-,— State: F—C
Zip code: _330� fax:
Phone No 'QS' — R,0 " 2.
E}Mail ,r lC1 C i S , 'Q/-&-47 0.-1 �1
state or County license
if value of constructlon Is 2500 or more, a RECORDED Notice of commencement Is required.
if value of HAVC Is $7,500 or morn, a RECORDED Notice of Commancement Is required.
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DESIGNER ENGINEER« Not Applicable MORTGAGE COMPANY: Not Applicable
Nance: 7' . SG11 h E—Y1593ja< Name:
Address: r Address:
City: State: City: State:
Zip: S Phone "7 ZIP: Phone:
FEE SIMPLE TITLEHOLDER: _ Not Applicable BONDING COMPANY: ,,,,,_Not Applicable
Name: Name:
Address: Address:
City, City,,
Zip: Phone: Zip: _ Phone:
OWNER/ CONTRACTOR AFFIDV T; 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 make no reprases�t tion that is granting a permit will aut prize the permit holdeC to build the subjects ructure
which is in conttict wifi any appires�be Wameiwners Asoction rules, byaws or an p covenants that may restrict or pro Ibit such
structure. Please consult with your Haase 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 5t, 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 falllure to Record a Notice of Commencement may result In paying twice for
improvements to your proplerty, A Notice of Commencement must be recorded in the public records of St.
Lucie County ansted on the Jobsite before the first inspection. if you intend to obtain financing, consult
with-krider or e aorney_Wore commencing work or recordLng your Notice of Commencement.
as Agent for Owner
STATE O-PB
COUNTY OF
sworn to (or affir ed and subscribed before me of Physical Presence car.. __ Online Notarization
this day of —L 204 by
3g )
Name of pcmon making/statement.
Personally Known V OR Produced Identification
Type of Identification Produced_..___
(Signature of Notary Public- state of Florida) iVotary puauG seta of Fior;n■
Commission No, (seat) pm�mlenlonGG239381
ON
Expfre5 iorM2022
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