HomeMy WebLinkAboutGerard Gilles Notarized DocAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
Building Permit Application
Planning and Development Services I
Building and Code Regulation Division Commercial Residential i�Ovy/E
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: L9 a �D r
Property Tax ID #: -� �� e>y `01
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
1CAn eUoJ
New Electrical Meter
(A
0 k l/J
Second Electrical Meter
CONSTRUCTION INFORMATION:
9
(Affidavit required)
Lot No.
Block No.
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: �7 Sq. Ft. of First Floor:
Cost of Construction: $ � I 0 0 Utilities: —Sewer _ Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name ( OG Cl -7Gt'( 01W r) "0 a ('n (e
Name:
_!.
Address: � WaC'C1
Company: \4� uuA YNrCDI0
sg z n; o ct t P bi0.
Address: �
r�10ni11
- \I e_
c T—
City: (�'� k -�� �-t✓>L C t � State: k_�
ZipCode:4CIS2 Fax:
Phone No. qw c I.39 E-
City: I�C`l St ILAC�tP
Zip Code- k 9Fax:
Phone No '% 9- - 06 ' 1 O
E-Mail
State:
(CA,
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
State or County License C q
If value of construction is Z500 or more, a KELUKUPW Notice or Lommencement 15 reyuneu.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTALCONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address : Address-.
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
Address:
Gty
City-.
Zip: Phone:
Zip: Phone:
OWNED/ CONTRACTOR AFFIDVIT: AAolication is hereby made to obtain a,oermit 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
bylaws that may restrict or such
which is in conflict with any applicable Home Owners Association rules, or and covenants prohibit
stcut,tace. please ccrosuit vatth yauc 4lome 0wrm-cs 4.ssotA-Amn ax A cevlew yottc deed foc awl cestcltiions whkh Mal aPPA' l
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.
Tk•'WA6V#Ane bwm5wy azne oxemw irm rr arxL-•gVnV a 'wtww a-d 4*h ns,
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 attorney before commencing work or recordippTur Notice of Commen ement.
Signature of Owner/ Lessee/Contra as Agent for Owner j�gnatrector/L' older
STATE OF FLORIDAIl-LL I TE OF FLORIDA
COUNTY OF COUNTY OF
Sworn to for affirmed,) and subbed before me of Sworn to for affirmed,) and sub sced before me of
✓✓Online Notarization
Physical Presence or ./ Online Notarization _ Physical Presence or
this IL day of e7C , 202V by this ? day of 'f� �l , 202/ by
�.;C ; Oe &7'lltr &9-rA,,-1 67 `lam
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification i
Type of Identificatio Type of Identifi&n
Produced f ��L
Produced
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G�ERLJL/N
(Signature of Notary Public- State of F ida•4.�G6pg� I� c''.9 Signature of Notary Public- State of F` da L••S4sACiy •.•%�
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