HomeMy WebLinkAboutHOWE PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: A- \Ol-O CM Permit Number:
s` f)
-= =- Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR:. PL1 C
Address: "ICJ l i t�� C�eC_� J..)` - " l`%%5 \'OY-'K 1 -�1 C-le, '�-6i"I6' LD
Property Tax ID#: 33529- )3-0100--000-a Lot No.
Site Plan Name: Co1y V 1\\O.S k � kyy ( oy, l lou aaa�} : t5ao-, CS block No.
Project Name: +OW\0- J
New Electrical Meter Second Electrical
Additional work to be performed under this permit -check all that apply:
Mechanical _Gas Tank _Gas Piping _Shutters
_ Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Constructions: n
Cost of Construction: $ :J-135
(Affidavit required)
_ Generator
Sq. Ft. of First Floor:
Windows/Doors _ Pond
Roof Pitch
Utilities: _Sewer _Septic Building Height:
�11,
GONTIRAI�IQOR*�
Name
Name
��''"" �a�
Address: Y-R
Company:
\e `f oil)YIIVIG'r
city. a cl 2.
Zip Code:3yg$Co Fax:
Phone No.elzj—Pie>s -En1L-8
State: F
E-
Address: 7
L ISM '(d\
CGIn - j
City. State: FL_
Zip Code: '5Q01&LP Fax:
Phone No
Mail: �Cp OEa6OLFQ_AG , WE)
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail Q M, �l �v (,,r
\iCl�a\�. Cod")
State or County License C�AC',1�1
Coco
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:
Name:
Address:
City:
Zip: Phone: _
Not Applicable I 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 attornev before commiaRcine work or recordine vour Notice of Commencement.
Signature of Owner/ LL ee/Contractor as Agent for Own
STATE C FLORIDA
COUNTY OF
Sworn to (or affirmed) and subscribed before me of Physical Presence or Notarization
—Online
this K day of �AO-f-e (nb2 f, 20, by
_ olro.\Q O'o.'(-\-hV-
Name ofperso king statement.
Personally Known X OR Produced Identification
Typ
/enn�tificcatiioon,P,roduced
(Signature of Notary Public -State of Florida)
SHARON MILLER
/^
G
. "SY°°el,
wsSCo of Florida -Notary
Commission No. eal)
pp, GG20Public
Commission fl GG 202177
�yiq° BPS My Commission Expires
'oninY�` Agril0l,2022
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SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
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REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED.
Rev 5/20/21