HomeMy WebLinkAboutpermit 1601 mallard ctAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
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21
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Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Commercial
I rrtulrwtu IMPROVEMENT LOCATION:
Address: 160I Hn\lard
Residential X
Property Tax IDtt: -, Ogoq 00a5-I30CJ -9 LotNo._pn�a
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
Q,qr
New Electrical Meter Second Electrical Meter
[CONSTRUCTION INFORMATION:
CI
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: $;4a6
Generator X Roof 3 1a Pitch
Sq. Ft. of First Floor:
Cast of Construction: $ v24;
, you Utilities: _Sewer _Septic Building Height: .4
OWNER/LESSEE:
CONTRACTOR:
Name_ -30 b 0n.
Name: q:r) "alo"9-
Address:_16oi M0114e6 C4.
,�
Company: 2U q fi 5 ICQ0
City: row 1 QSC9- StateVelAddress:
Zip Code: 3y�tJ'A Fax:
Phone No.
I `c,\\a Sw l -, ` `m%, 54 -
City:'7V,+ 5r• LuGiZ.
t Stater
Zip Code: 3 f q t3 V Fax:
Phone No 77- - 370- 9770
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above I
E-Mail �C 904 (,.1i L_aC FJ Cily/Qi
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State or County License_ '(�C7,3 306' f
....-.-, W 6G U W11111MILCI11Cnl M MgUlreO.
If value of HAVC Is $7,500 or more, a RECORDED Notice of Commencement Is required.
Name:_
Address
City: State:
Zip: Phone-
'
FE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
City:
Zip: _ Phone:
MORTGAGE COMPANY: Not Applicable
Name:
iAddress:
City: State:
Zip: Phone: —"
BONDING COMPANY:
Name:
Address:
city:
ZIP!— Phone
—Not Applicable
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that noworkor installation has commenced prior to the issuance of a permitp ie
wh ch is in contflimawith any applicable Home Owners Association ru Ies abylaws or and covenants that may restric
t o 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 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 anoth
er non-residential use
a Notice of
WAimprovemeNG TO Onts toy ur property. ur failure toA Notice of Commencement must be rment ecorded isult in n the twice for
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 attorne before commencin work or recordingour Notice of Commencement.
Signature of Owner/ Less / ony actor as Agent for Owner
STATE OF FLORID
COUNTY OF
Sworn to (or affirmed) and subscribed before me of
x Physical Presence or_ Online Notarization
this day of 2020 by
Name of person making statement
Personally Known O- OR Produced Identification
Type of Identi£ication
Produced
A
(Signature of Notary Publ, - ate of Florid
Commission N
REVIEWS FR T MY
CCU
re
STATE OF FLORIDA
COUNTY OF 5�- /y r_('¢,
Sworn to (or affirmed) and subscribed before me of
'�- Physical Presence or Online Notarization
this_day of —" 2020 by
Name of person making statement.
Personally Known i_ OR Produced Identification
Type of Identification
Produced
(Signature of Notary e of Florida
CtOr Q AItArlZip
Commission Na. N
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