HomeMy WebLinkAboutapplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
C` — ELI Q
' 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 CBDG Funding
PERMIT APPLICATION FOR:--f
Address:
I3-th 15T
PropertyTax ID #: �2-L 4 - 1 r+ Z--MD 96-"00l- I
Site Plan Name:
Project Name:
New Electrical Meter Second Electrical Meter (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 L 12-- , Pitch
Total Sq. Ft of Construction: fl 1 Sq. Ft. of First Floor:
Cost of Construction: $ 52- ) ,QQ Utilities: —Sewer _Septic Building Height:
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}OWNER/LESSEE �L , �
Name A 1 L God tzibor- Yrn
Name: G r
Company: H vo
Address:' i( et I J W )' I ��
Cit C�t - State:
Address:8 �� �� ;�
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Zip Cods7 Q Fax`
City�O�1lx _ State:
I
Phone No. %i- J 1 Z 7 (0 E-
Zip Code:: Fax:
Mail:
Phone No
E-Mail YY" C2-0rOif t (0 CWOiL, r(
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
State or County License L- 1
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.
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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:
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.
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
which conflicts with any applicable Homeowners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Homeowners 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 attornev before commencing work or recording your Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA - LC_COUNTY
OF
Sworn to (or affirnMd) and subscribed before me of v
Physical Presence or Online Notarization
this day of V'GTJ9W 20a (by
C i
Name of pe n aking sta ent.
Personally K wn 1 OR Produced Iden� if' � ation
Type of Id nti is io Produced
(Signatu e o ry Public- State of Florida)
Kenny Hanzow
Commission No. (Seal)
Notary Public
*VIS
State of Florida
Comm# HH087667
Expires 2/1/2025
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