HomeMy WebLinkAboutKings Highway Building Permit App - SignedAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: I Z t I-t I Z Permit Number:
gy" ILUC1JL -� \
F'q4CI��!'EO 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
CBDG Funding
Residential
e-10G5 4i i otwR•i Lo6ttT1C.S C:£&-,Tt E
I PROPOSED IMPROVEMENT LOCATION: I
Address: > -60 T pm a..OE
PropertyTax ID #: —GDd
Site Plan Name:
Project Name: 14'1 (Ad WWI
DETAILED DESCRIPTION OF WORK:
os" ((.q. 000
1v' 0 SIZ4.rvl tL SY.Ct M
New Electrical Meter Y Second Electrical Meter
CONSTRUCTION INFORMATION:
w
(Affidavit required)
Lot N
�1:7a3R•�
Additional work to be performed under this permit— check all that apply:
Mechanical _ Gas Tank _ Gas Piping _ Shutters }C Windows/Doors _ Pond
Electric K Plumbing XSprinklers _ Generator Roof Pitch
Total Sq. Ft of Construction: A !J , 60 T, Sq. Ft. of First Floor: 6ty. vdrJ �
1
Cost of Construction: $ 46,E OLIO Utilities: Sewer _ Septic Building Height: 43
OWNER/LESSEE:
CONTRACTOR:
Name C--,Or — SEA -I RIND -(:;" C"J_7, ZOU uL
Address: 3333 >Lwao &,WJ STM 4a0
City: State: 1f�'
Zip Code: 3633` Fax: _
Phone No. -toy 233 e)2-0y E-
Name:
Company:
Address:
City: State:
Zip Code: Fax:
Phone No
E-Mail
State or County License
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
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.
DO
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: Not Applicable
Name: 6_<-(aKj c e_ higoH-txt Ae&Hr&67�
_
Name:
Address: 7,-n-i 2&=15S FiJfA4 pw- _ .no
Address:
City: iAArZ� mm State: Cam►'
City: State:
Zip: 30'33 Phone `p® - cA%Z. —54 oo
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: _KNot Applicable
Name: � q"e iz Name:
Address: L*ww&oD w_w Sty v Address:
City: ftfEgiz1- C* -_ City:
Zip: 3o33fl Phone: boy Z-33 ozov 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
bylaws
which conflicts with any applicable Homeowners Association rules, 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 unty and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
with I der r an attorney before commencing work or recording our Notice of Commencement.
Sigr0ture of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FheRtBA 6eraz ;iA
COUNTY OF
Sworn to (or affirmed) and subscribed before me of Physical Presence or Online Notarization
this day of I1-�.Im L 20,1�1 by
Oil/
Name of person making s emen .
Personally Known OR Produced Ide tification
Type of Identificati n Produced
(Signature of N
Public- State of-Fle-* a)
o, .
Commission No.
GISELLERgMpQ r
UBUC
DeKalb County
State of Georgia
My Commission Expires May S. 20Z8
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