HomeMy WebLinkAboutBUILDING PERMIT APPEI= L-
Property Tax ID#: I -.L — _�
Site Plan Name: MO"-g: Cz4TKL.0 �3vkra-12ti
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Project Name:E rZ-0 0#-
DETAILED DESCRIPTION OF WORK: --
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New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
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t'1 E VA
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(Affidavit required)
1
Lot No. 227
Block No.
Additional work to be performed under this permit -check all that apply:
Mechanical — Gas Tank —Gas Piping Shutters
— Windows/Doors P
— Electric — Plumbing — Sprinklers
Total Sq. Ft of Construction: [}
Cost of Construction: $ IL&LL°d
OWN ER/LESSEE:
and
Generator, ✓ Roof ` G tch
Sq. Ft, of First Floor:
Utilities: —Sewer _Septic
Name GregoSime
Address: 9516 Shadow Lane
City. Fort Pierce State: FL
Zip Code: 34951 Fax:
Phone No. 772-461-1218
E-
Maii: Glo .s.,, — _ G:1 - ..I _ -
Fill in f6e simple Title Holder on next page (if different
from the Owner listed above)
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Bate:
Permit Number.-
LuGtiI
Punning and development Services Building Permit Application
Building and Cade Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 Commercial Residential
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding_.
PERMIT APPLICATION FOR: TI F - 4:
} PROPOSED IMPROVEMENT LOCATION:
Address: `t-�i 16 �5 l,4.-.00W -fir
Pt'e
CONTRACTOR:
Building height:
Name: Robert Diedrich
Company: Leeward Roofing
Address: 9577 Gator Drive, Unit #5
City. Sebastian State: FL
Zip Code: 32958 Fax: 772-589-2429
Phone No
E-Mail Gp r 4
State or County License CCC#1326409
If value of construction is 25ap ar 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:
Name:
Not Applicable
Address:
City: State:
Zip: Phone
FEE 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.
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 attorne before commencin work or recordin our Notice of Commencement.
ure of Owner/ Lessee/Co r c6 as Agent for Owner
STATE OF FLORIDA
COUNTY OFX,,& Qvu-
Sworn to for affirmed) and subscribed before me of f
this jLl�_ day of2Q,9J_ by
Name of person making statement.
Personally Known OR Produced Identification
`type of Identification Produced
ure of Notary Public- State of Florida)
Commission, No. WW (A 622J (Seal)
REVIEWS FRONT ZONING SUPERVISOR
COUNTER REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
DAVID W GIINN
Notary Public
State of Florida
Connor# HHM6221
Wres 2/221202S
Physical Presence or Online Notarization
EIAWD M DAWN
Nary Public
State of Florida
COMM* HHM622I
REV EW VREVIEWON I S REVEWLE M EVIEWVE