HomeMy WebLinkAboutBuilding Permit Application i 2
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: QA I c�-j on 11 .
9TFo[L CKE
RECEIV
o .-- ^f- Building.-Permit Applicata®
Planning and Development Services N�� 3 ® 2�2�
Building and Code Regulation Division Commercial Re it e.ntia-Ir.. X "`��
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 CBDG Funding
PERMIT APPLICATION FOR:
PROPOSED I.MPROVEM ENT,LOCATION:
Address: 10197 Indian River Dr. Fort Pierce FL 34928
Property Tax ID#: 3529-233-0002-000-3 Lot No.
Site Plan Name: Pennell Michael Block No.
Project Name: Pennell Michael
DETAILED DESCRIPTION OF WORK:
tallation of 500 gal Ip tank.
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 _Plumbing _Sprinklers _Generator _Roof. Pitch . . .
Total Sq. Ft of Construction:
Sq. Ft. of First Floor:
Cost of Construction:$ Utilities: _Sewer _Septic . Building Height:
OWNER/LESSEE: CONTRACTOR:.
Name Pennell Michael Name: Jesse Rack
Address: 10197 Indian River Dr. Company: Rack Fnernv I I C.
City: Fort Pierce State: FL Address: 153 NW 16TH ST
Zip code: 34928 Fax: City: Boca Raton state:
Phone No. 954-856=6221 E- Zip Code: 33432 Fax:
Mail: mgpennell@comcast.net Phone No 561-391-3550
Fill-in fee simple Title Holder on next page (if different E-Mail info@rackelectric.cbm
from the Owner listed above) State or County License LQ-34297/ LI-45024
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.
SURP.LEIVIE�JTAL CO RI:S TRU CTION LIE�J: LAW IN.
-.DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Rlot Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
OWNER/CONTRACTOR AFFID.VIT: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 anyy 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 a r f Owner/Lessee/Contractor as Agent for Owner
ST E OF FLORIDA
COUNTY OF Florida
Sworn to(or affirmed)and subscribed before me of X Physical Presence or Online Notarization
this 14 day of Oct. ,20 21 by
jbh-In ') , Pac*_
Name of person making statement.
Pers al own /OR Produced Identification g �` :_ TIFFANY
Type f I en ificat n Produced ; :off MY COMMISSION#HH 098695
EXPIRES:June 29,202525 ,
BWed TAN Put&UIId,,,t,,
(Signs u otary Public-State of Florida)
Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 1