HomeMy WebLinkAbout8917 CHAMPIONS WAY, PSL, FL. 34986 SLC PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Permit Number:
Date: S
L O Eu 1
0 rAa
2 1 ° ' WU Building Permit Application
Planning and Development Services
Commercial Residential
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462_1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: , ' •r '6L -
PROPOSED IMPROVEMENT LOCATION:
Address: 1
Property Tax I D #: tr1-50 I
Site Pian Name: L�7
Project Name:
nPTAILED DESCRIPTION OF WORK:
New Electrical Meter -" Second Electrical Meter
CONSTRUCTION INFORMATION:
4L A
Lot No._J__
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� Pitch
—
— Total Sq. Ft of Construction: 5q. Ft. of First Floor:
Cost of Construction: $ Utilities: —Sewer — Septic Building Height:
OWNERAESSEE:
Name Yr �
Address: +
city: Thau_
State: i
Zip Code: 1 Fax:HI-- 3 I - qOb 1
Phone No. _ �
E-Mail:hldff
Fill in fee simple Title Holder on next page ( if different
CONTRACTOR:
Name:
Company:
City: Stater
Zip Code: Fax i!���
Phone No_` 1Z- 5�( Ll L4
E-Mail Y ; }9 '�c�"*l"
State or County License r r� � �� 3
from the Owner listed above)
If value of construction is 2500 or more,
CORDEDof Notice of
Commencement
omme Commencement se t is required.
if value of HAVC is $7,500 or more, a RECORDED ice
SUPPLEMENTALCONSTRUCTION LIEN LAIN INFORMATION:
DESIG-E-MENGiNEER:
Name:
Address: _ -_—
rity•
Zip;_ Y Phone
Not Applicable
Stater
FEE SIMPLE TITLE HOLDER: 7Nr Not Applicable
Name, —
Address:
City: _ Phone'
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:.
BONDING COMPANY:
Not Applicable
C
State: #
i
LNcit Applicable I
Name,
Address:
City:
_ Zip: Phone: —
CONTRACTOR
R CTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
OWNER/
I certify that no work or installation has com-nenced prior to the issuance of a permit.
St. Lucie Countyy males no representation
aC)iwners Asgac ationirules, ill authorize
or andpcovenants that to mayrestrict the bor prohiStrbit�selch
which Is in conflict µnth any app°
structure, Please cv with
with your Home Ov ow Association and review your deed far any restrrctlons which may app y.
in consideration of tF a granting of this requestoe �permit, ngCodes and .St Lucagree e Coulnity Amendmeents�Qrform the work
in accordance with ti - approved p,an�, the
The following buildin;; permit applications
are
exempt from
sun undergoing
a full and accessorency rev
ry uses to another noniew: room -residential use
accessory structures, swimming Poo � twice for
WARNING TO OWNER: Your failure tc Record a Notice of Commencement may result in paying
improvements to your property. A Notice of commencement must be recorded in the public records fend to obtain financing, St,
Luce County alid posted on the J!obsi�� no' e tng �9rk orirst lrecordipn Iou�Notice of commencement,
wit 1 lender cr aim attorne` before co
..
Sign Lure of O nerf Lessee/Contractor as Agen' for Owner l Signature of Contractor/License Holder
STATE OF FLORID
t� LW
COUNTY OF—_
Swprn to (or affirmed) and subscribed before me of
4 ysical pre nce or Online Mctarizntion
this day of , 2021 by
Name of person ma (:ng statement.
Personally Known OR Produced identification
Type of Identificati3n
Produced __---_.--
t Y. JULIE JANE MCCAUL,
Notary Public - St. ei F
Commi55lo _ ommnsion S HH 49824
of My Comm. Expires Oct 1, 2024
STATE OF FLORIDA� f �L�
COUNTY OF -- —
Sworn to (or affirmed) and subscribed before me of
v Physical Pre ence or Online N o�t Notarization
this jg-- day of rc
by
WA f3 �
Name of person making statement.
Personally Known ✓ OR Produced Identification
Type of Identification
Produced
(Signature
.00 ft"' ••. JULIE JANE MCCAULEY
[Drr. rn15510 Notary Public • State of Floe£ I )
ommission I HH 49824
`,'?pr My Comm. Expires Oct 1, 2024 iW
n099ffl9 MIALIin�
FRONT ZONING SUPERVISOR PLANS VEGETATION SEA REVEWLE MANGROVE
REVIEW i
REVIEWS REVIEW REVIEW REVIEW --- .i
COUNTER REVIEW -
DA_
DATE -
COMPLETED