HomeMy WebLinkAboutSmith - Permit Application.pdfAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date
Permit Number:
`1 LLICLL
c L C 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: RE - RC(F
PROPOSED IMPROVEMENT LOCATION:
Address: 4908 PALMETTO DRAVE, fV-9-T PIECE, FL 3*9$2
Property Tax lDq: 3iOq�03 Lot No�3Y2 ZZ
Site Plan Name: 4908 PAI.ME'(`m -MyE Block No. U0
Project Name:
DETAILED DESCRIPTION OF WORK:
r* I" NA(Ls`riz-I P
JG SHIN4tf-s AND WPIATCI14
If C-471 5-rr%D1NEf Sc-ti1-M 9t)OR
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit- check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors _ Pond
_Electric _Plumbbing _Sprinklers _Generator �Rootof 3/2?4/ZPitch
CI
Total Sq. Ft of Construction: 3, ma Sq. Ft. of First Floor: 3, a'
r
Cost of Construction: $ `�J. W a �, 957 - oo Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name "CIENE B sm"
Name: All IANX CInUP GOWIEACIA4
Q9P
Address: 4%6
PAWEM WME
Company:-t)otNIC-4l R-YaMANI
City: fW PILULE State: FL-
Zip Code:3"el �1 Fax:
Phone No. LfA 5- 0.3I - 6 9. 75' E-
Address: 05 NVV ENTER ME IDOW
City: P6(LT Sr LUCAC Stater
Zip Code:3100(p Fax:
Phone No
Mail: aVQ171a ft Vlt%VX)• 661(0
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mails
naI •GO►yl
State or County License CCU 3�
If value of construction is 2500 or more, a RECORDED Notice of Commencement is requires.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
N UEN LAW INFORMATION:
"Mr a r
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: _Not Applicable
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 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 commencing work or recording vour Notice of Commencement.
Signatur f O net/ Lessee/Contractor as Agent for Owner
STAT F FLORIDA
ST UAGE
COUNTY OF
v
Swo to (or affirmed) and subscribed before me of Physical Presence or _ Online Notarization
No
this dta. of ��IOVEM� 2021 by
VAA e%C— 94c4m&N
Name of person making statement.
Personally Know OR Produced Identification
Type o�f Identificationr
Produced �f �/ L
L tiioi�I W .��CF'!!�
(Signaturebt Notary Public- S ate of Florida)
ELiZABETH A. SCILER
�
Commission No V (Seal) Notary Public, State Of FloridaCommission No. HH74732""'�My
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Commission Expires: 12122/2024
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ev 5/20/2