HomeMy WebLinkAboutMeyer-Harrison Permit applicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
.�o LC�11L
�PAAM
M0715'at— `z
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-I553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: _.5.zEI,4 RUSSaKjis RE frert PiarrceF L 344s,
Property Tax ID #: -- 001-00CY.-Z Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
t
New Electrical Meter Second Electrical Meter
(Affidavit required)
I CONSTRUCTION INFORMATION: I
Additional work to be performed under this permit -check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters Windows/Doors Pond
— Electric — Plumbing `Sprinklers
Total Sq. Ft of Construction: _7 Lf q 'T
Cost of Construction: $
Generator k Roof 7Zi� Pitch
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
Name: �j;I&n Loki_
Company: i i n�Q0t_24
Address:
City State: _
Address: 49 P1 #LQ i I/
Zip Code:31q_5 1 Fax:
City: State:
Phone No. -51 E-
Zip Code: YZ !W , Fax:
Mail:
Phone No yS1--Q7
E-MailJ2%* i ph ���� p¢';,R60F
State or County License16'aJeW
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Ct
IT vawe oT construction is 2SOU 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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
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 grantin a permit will authorize the permit holder to build the subject structure
which conflicts with an 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 attorn ey before com me nci ne work or record 1n our Notice of Commencement
Signature of Owner/ Lessee Contractor as Agent fror owner
STATE OF FLORIDA !
�► v`e i
COUNTY OF VLgl oty,
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this 17 day of _rQVeM fir20211 by
i OtA Co we r
Name of person making statement.
Personally Known -< OR Produced Identification
Type of I ratification Pro aced
(Signature of Notary Public- State of Florida)
�F1860
Commission No. {Seal]y=Notary
...... DANIELLA olnnINICFi
Florida
Public -State of
+= Commission N HH 98607
�*
? My Commission Expires
��February 28. 2025
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