HomeMy WebLinkAbout212 OLIVE AVE PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date
Permit Number:
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�.:...
E c t� 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:
PROPOSED IMPROVEMENT LOCATION:
Address: l A'/'C 86 ^4- .S t- Z_
Property Tax ID #: 3 k-j J `/ ) '� Lot No.
Site Plan Name:
Project Name: _�7'` ,- ,�� .� -' ,�., ; �: "
�:,;
DETAILED DESCRIPTION OF WORK:
Block No.
s j ! ' "''tie:
r
r'('V p,F q� K 9 C r-i--,-i �nw- (—1 Sh k n k9 l `� tf j Li — � i f � r�..�e{'�
R),i; Gt i,)F?, '; 1 . 3e
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
(Affidavit required)
Additional work to be performed under this permit - check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors Pond
_ Electric _Plumbing _Sprinklers _Generator ;/ Roof / Pitch
Total Sq. Ft of Construction:Sq. Ft. of First Floor:
Cost of Construction: $ GI 00(—) Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
Name: � rm z' -+ � -` C afro -4-rz r > '.n
Address: 10- 0),'Lc..
-
Company: :- �74jsti' z• t, n
City: �4, 0-t' C C e -c- State: _
Zip Code: �) L/ Q j— J_ Fax:
Phone No. .S- U l - fig 3 �- -- 6 p 6, Q' E-
_Frc,,`zJ .-
Address: 7.1 !J A- c,r-
City: J` f� ,^ �. ,, +r '�, %, s j State: P /-
Zip Code: 3 1. 7 cl I Fax:
Phone No q ;�,c
Mail: i SI B (>(_A , t•jyj
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail f
State or County License Cc- 1:33 = 4-7
ii vdluc ui 61JrI5LrUL1iun Is LSUU or more, a KtwKutu 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 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 attorney before commencing work or recording our Notice of Commencement
Si ture of Owner/ Lessee/ ontractor as Agent for Owne
Rev
STATE OF FLORIDA
COUNTY OF
Sworn to (or affirmed) and subscribed before me of �XN
Physical Presence or Online
Notarization
this -'),q day of V--k?.r. , 20I by
Name of person making statement.
Personally Known C OR Produced Identification
Type of Identification Produced
'(Signat e o ary Public- State of Florida)
Commission No. � tth o'�';`.°;'s�,�,
�' � ��(Seal)
LINAMARIAGOMEL
Commission #NH076897
ce
Expires January 4, 2025
9TFOFFLOP\
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