HomeMy WebLinkAboutSLC Permit App - SquadritoAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: q . Permit Number:
Lo
Building Permit Application
Planning and Development Services
Building and Cade Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR: rLwcL
PROPOSED IMPROVEMENT LOCATION:
X
Address: 7-Vi1e. L�. A_t%jLr,
Property Tax ID #: E�02 dDo, vac '7 Lot No. I
Site Plan Name: S'fbL!A&"?ci! : 4-WCz Block No.
Project Name: i^,c -7az�
DETAILED DESCRIPTION OF WORK:
s &UL S11-11- iYAih i - L--h
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit- check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters
— Electric — Plumbing — Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ / a, " 2-In . L) a
(Affidavit required)
Generator
Sq. Ft. of First Floor:
Windows/Doors Pond
Roof Pitch
Utilities: —Sewer —Septic Building Height:
OWNERAESSEE:
CONTRACTOR:
Name r`�I�r,2l� SQ ic:�r�rt1 i a
Name:
Address: -441 .r-4L; eL"irL6 /YfL/L^
Company: A
City: Pd:Lr S: Lu& & State: r=z_
Zip Code: -Tg YS3 Fax:
Phone No. -7-1 ,z L?y 2 -ivsa.s E-
Address: 7 5 P AJ1,Lj L=X i7_ALPPLiA'4`lit
City: Joe : r L or:.: L:�- State:
Zip Code: ; 1 «4; Fax: i 7z. q00 o2,72-
Phone No 7?2 Si?- v 2.-z-3
Mail: P-1Ks 7i LGd C. ,fire e'esi24
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail im i�e C &L&W7- F1_A e_ r Ld .s7
State or County License C GC 1-!CZ -75- 7/
� VC1 UV= U! wiI,uucLIVn ,s caves or more, a KULUKOW notice or 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:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City: State:
Zip: Phone:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: Not Applicable
Name:
Address:
Address:
City:
Zip: Phone:
City:
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, 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 ald pod on the jobsite before the first inspection. If you intend to obtain financing, consult
with lender or An att rney before commencing work or rPrnrriinp vnttr Nntira of f nmmonrnrnnnt
l
Signature of Con recto - o - OwnerWilder alder s applicable
STATE OF FL 'RIDA
COUNTY OF ,
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this Y day of f-'Ci3rLwtLy , 207.2-by
L >+"tte ele_ !. �7 :I- d LL 4
Name of person making statement.
Personally Known X. OR Produced Identification
Tyr Identification Prodd
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(5i atur f Notary Public- State of Floe}
F J
Commission No,I Z l(seal)
Notary publi State of Flanaa
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