HomeMy WebLinkAboutwh.permit.SquiresAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: l It 7-® 2-4
Permit Number:
9M Wcm
C}
Building Permit Application
Pianning and Development Services
Building and Cade Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1SS3 Fax: (772) 462-1S78
Commercial Residential
PERMIT APPLICATION FOR: still..}, �—
PRUPIED I11iiPR(VEIViENTi�CATION: +�KA
Address-
Property Tax I D #: (� — �O I - I sl®I - ��� , Lot No.
Site Plan Name: Stock No.
Project Name:
DETAILED' DESCRIPTION OF WORK:
i+f�
New Electrical Meter Second Electrical Meter
CONSTRUCTION I-NFORMATION:
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:
Cost of Construction: $a ® utilities: _Sewer _Septic Building Height:
U -NER/A ESSEE.
Address:_ `�.. (mac A VA - ne
City: ac-4 5+ State: FL
Zip Code: 3L4CfS a Fax:
Phone No.
E-Mail:_ 11or�p
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
NQCT:
Name:
Company:,.
Addres
City:`" L U Stater
Zip Code: Fax:
Phone No '77 2 - 32 Z�
E-Mail
State or County License
If value of construction is 2-500 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.
Name: — - --- - •�-r....�...�
Address:
city: State:
P.
Phone
SEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address: .
City:
Zip: Phone:
MORTGAGE COMPANY: 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.
w Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in corl#lict with any applicable Nome 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, l 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
for
improvements to your property. A Notice of Commencement must be eco recorded nesult ina h pub) c records of St
�lLucie county and posted on the� 'obsite before the first inspection. If you it.�7Stend to Obtain financing, consult
%,�lenc r Or an attorney bef commencin€r wnrL- nr--,..Fr — ..,..._ s,-de--
Of
as Agent for
STATE OF FLORIDA
COUNTY OF �7 LkiCA e.
Stn►o n to for affirmed) and subscribed before me of
P�y,4#cal Prese ce or Online Notarization
this ff day of Cr, Xr ` �, 202# by
-rites
Name of person making statement.
Personally Known OR Produced Identification
Type of identification
Produced
ti
(Signature of Notary PuE»
:t►"• MANE COLE
Commission No. = Nota h state of Florida
`= C OL d GG 961089
`t My Comm. Expires Mar 14, 2024
STATE OF FLORIDA
COUNTY O; S'I•� e,t
Sworn to (or affirmed) and subscribed before me of
�'' Sys#cal Pre!en�orOnllne Notarization
This J—da of 202# �by
Name of person making statement.
Personally Known V10, OR Produced Identification
Type of Identification
'(Signature of Notary Public- State of o
DMNE CC
t Notary Polk - 5ta
Commission No.commission it G
Y COM111. Expired
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COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW 1ATE
202,
Assn