HomeMy WebLinkAboutPermit AppAll APPLICABLE INF MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: I 1Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Commercial
CBDG Funding
Residential
PERMIT APPLICATION FOR: ESE -NCY AC ('.-Ike &C OUT- — L2KE FoX Lx
PROPOSED IMPROVEMENT LOCATION: + l•i
Address:
PropertyTaxlD#: ,34.2Jr-101-0132-060"0 Lot
Site Plan Name: Block No. _L
Project Name: SAI,1115S RES r.l->Ei V-G
DETAILED DESCRIPTION OF WORK:
GMERGUNC yA, ' c ('4MA &E
StiSTALL A H - r-a>y 14 s
�hi4 A IbkW HGPTE:R
New Electrical Meter Second Electrical
CONSTRUCTION INFORMATION:
Additi al work to be performed under this permit- check all that apply:
Mechanical _ Gas Tank _ Gas Piping _ Shutters
Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction: 1! 50
eo
Cost of Construction: $ (0-3 5
,
(Affidavit required)
Generator
Sq. Ft. of First Floor:
QTT
-Windows/Doors _ Pond
Roof Pitch
Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name SkAN SA► M,;
Name: ��
Address: $A[22 CSf4 NAMOU LAME
Company: rN-ZT=-(
-INC -
City: � 6e SA wl- ZI.ICrE State:
Zip Code: Fax:
Phone NoW qy g967 E-
Address: Z5LM 5 IULT-TAAY1AL
City:WE
Zip Code:
Phone No_sw C133
Fax:
.21 9
State: F
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail de rM i'f'S
'? a-C {'I
I AC . co rn
State or County License CAC
1'L4Q p L
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.
DESIGNER/ENGINEER:
_ Not Applicable
MORTGAGE COMPANY:
_ Not Applicable
Name:
Name:
Address:
Address:
City:
State:
City:
State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
ZNot 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 %anting 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 l 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, w Is, signs, screen rooms and accessory uses to another non-residential use
WARNING TO OWNER: Your failure to cord a Notice of Commencement may result in paying twice for
improvements to your property. Notice of Commencement must be recorded in the public records of St.
Lucie County and posted on th obsite before the first inspection. If you intend to obtain financing, consult
with lender or an attornev bef re commencing work or recording your Notice of Commencement.
i
Signature of wner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA"
COUNTY OF �SATWC I-ULCT-
Swor to or affirmed) and subscribed before me of Physical Presence or _ Online Notarization
this ay of (kT06eq, 20,U by
MARK A Vz:ges
Name of person making statement.
Personally Known _ZOR Produced Identification
Type of Identification Produced
(Signature of Notary Public- State Flori a)
Commission No(Se�Wary aubecStateorF!onda
nalls� s ltlnq
mCommission G33991 2
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