HomeMy WebLinkAboutLori Kandill Permit applicationP
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: a Permit Number:
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce Ft 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: q
Property Tax ID #: - m0 Lot No.�^
Site Plan Name: 1 Block No.
Project Name: io(i Q�
DETAILED DESCRIPTION OF WORK:
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1
New ectrical Meter/(Affidavit
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: $ D Utilities: _Sewer _Septic
Building Height:
OWNERAESSEE:
CONTR OR:
Name
Name:
Ile
Address:
Company: F.
City: State:
Zip Co e: 4d4 k I Fax:
Phone No. E-
Address:
City: l - State:
Zip Code. Fax:
Phone No n.3qp
Mail:
Fill in fee simple Titie Holder on next page (if different
from the Owner listed above)
E-Mail b AI-W - ( I
State or County License
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.
A
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION,
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: _Not Applicable
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, wails, 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 attornev before commencine work or recordine vour Notice of Commencement.
Si tureofContractor-or- nerBuilderasapplicable
STATE OF FLORIDA c, I J%
COUNTY OF t_JT �J t
G
5wo n to (or affir and subscribed before me of OPhysical Presence or Online Notarization
this day of 20�by
Name of person making statement.
Personally Known _�O_ OR Produced Identific ion
Type of I en " ication Produce
,'_ �) h6ke;_t� Y
(§Ifnat Tre of Nota ublic- tate of Florida)
i ry `A Notary PuVic State of Flosda
Norx-r �Da 60)(Seal) Melissa L Butterfleld
Commission My Comnssion GG 302065
fExp,es 02n412023
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
xev lU/11/21