HomeMy WebLinkAboutSTACEY KEENAN PERMIT APLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION
Date:
BE ACCEPTED
Permit Number:
> L tA'. 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: "S PsGE. Y�'
Z_F_,k)PQ 1,5r C 0 C).�
PROPOSED IMPROVEMENT LOCATION:
Address: `;_�Lon2) y _ iN O t-
Property Tax ID #:
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
LOOE for
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit -check all
'_MeChdnlCdl _ Gas Tank _ Gas Piping
Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction: Sq
Cost of Construction: $ Utilities:
1 Lot No. 2-0
Block No. 100
cc
(Affidavit required)
at apply:
Shutters Windows/Doors _ Pond
_ Generator _ Roof Pitch
:. of First Floor:
-Sewer —Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Lk )A&_F_N"4
Name:
Address:::��L—,, r�c".c��.("',c= c. �\uF_
Company: C� s�i A`
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City"�
: '� =� • � : � Cc_z., State: � 1
Zip Code: Fax:
Phone No.E-
Adldress• '��. i- a.�C\ • � � � u 2 �
\- 1 1
City:State: 5,71
Zip Code: 'yc Fax:
Phl ne Now VL 3 �rSLA
E-Mail C Uo V k"C
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
State or County License C' . ,C t ? U`J `{ Cam,
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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name: _
Address:
City:
Zip:
Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
_ State: City:
Zip:.
Not Applicable BON
Nan
Adr
Cit
ZI la:
State:
Phone:
NG COMPANY: _Not Applicable
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 rev+eyu your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree ree that I will, in all respects, perform the work
in accordance with the approved plans, the Florida Building Codes and t. 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 roorrs 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 attorr1ey befo commencing work or recording our Notice of Commencement.
JA-
D(1 'V
4,k �W
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Signature of Contractor - or - Owner Builder as applicable
STATE OF FLORIDA
COUNTY OFF .
Sworn to (or affirmed) and subscribed before me of
Physical
Presence or Online Notarization
this day of _ �. 202L-by
Name of person making statement. l Lj
v
c
Personally Known �, OR Produced Identification
Type of Identification Produced
(Signature of Notary Public- State of Florida)
i
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":
JANICE GERROW
Commission No(G�Z`���i� Seal
( )
MY COMMISSION # GG 259744
EXPIRES:: S,{e�plAm.`,be�r i8, 2022
Swded Ttuu Notavy PYuw UiWww i m
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FRONT
ZONING
SUPERVISOR
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SEA TURTLE
MANGROVE
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DATE
RECEIVED
DATE
COMPLETED
Rev lu/1L/L1