HomeMy WebLinkAboutMaliszewski Gen Permit Applicationlc,
All APPLICABLE INFO MUST BE CW 1PLETED FOR APPUCATION TO BE ACCEPTED
Date: Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial
23M Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: 'Pooi 7
�Y i�QI��(t
PROPOSED IMPROVEMENT LOCATION:
Residential
r' • -Property Tax ID C9 I Lot N'D.--i-
Site Plan Name:
Project Name: Gc-&-Mky
New Electrical Meter -- Second Electrical Meter (Affidavit required)
F�ONSTRUCTION INFORMATION: -
Additional work to be performed under this permit —check all that apply:
Block No.
Mec nical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors _ Pond
/Electric Plumbing _ Sprinklers ✓Generator —Roof _ Pitch
Total Sq. Ft of Construction: eq,,Q Sq. Ft. of First Floor:
Cost of Construction: $ ( -1,Pr5. oo Utilities: _ Sewer _ Septic Building Height:
O IER/LESSEE:
Name 4.ltKr 1 r i
Address:
City: PC a S'T if Itle State:
Zip Code: Fax:_
7 •.5 Q<3 a
CONTRACTOR:
Company:,
• t►r1Al��r�►I.
State
Phone No.
E-Mail: Pe-k ✓ /'Y)v P 1l @ - io al= Phone No ��
Fill in fee simple Tide Holder on next page ( if different j E-Mail C,
from the owner listed above) State or County License _ I (Oa- q
If value of cmistrruction is 2soo or more, a RECORDED Notice of Commencement is required -
if value of HAVC is $7,5W or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: of Applicable MORTGAGE COMPANY: Not Applicable
Name:
Address:
City: State:
Zip: Phone.
FEE SIMPLE TITLE HOLDER:
Name:
Address:
rites:
Zip: Phone:—
Ndt Applicable
Name:
Address-
City: State:
Zip: Phone:
BONDING COMPANY: _Not Applicable
Name:- -
f 'arlrirpW
-6tv:-
IZip: _ Phone:
I �
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 is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home owners 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 1 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 resuk 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
witFiisedpr qr an attorneybefore cam work or recording -your Notice of Commencement.
Signature of Ownerl Lessee/Contracnt is Agent for Owner
STATE OF FLORID J
COUNTYf
Sworn to (ed a ubscri before me of Physical Presence ar Online Notarization
this d20 by
Name of erson making statement.
Pe on ly Known , OR Produced Id ' ii c ion
Ti ontifrrati[1n.AYntlti[p[I
of Notary Public` State of Florida )
No. GKo ZzSgZ / (Seal)
REVIEWS FRONT ZONING SUPERVISOR
COUNTER REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
�y f4N
Notary Public State of Florida
X4. Charmin D WalkerrMyCommission GG 225827 Expires 0610612022
PLANS I VEGETATION 1 SEA TURTLE
REVIEW REVIEW REVIEW
I
MANGROVE
REVIEW