HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFD MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number: D� I - 010 O
Building Permit Application
Planning and Development Services St- Peale COU ty
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone:.(772) 462-1553 Fax: (772) 462-1578
PERMIT ARPl_ICATION FOR: DCA Modular placement on property
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Address: 11292 ORANGE AVE FORT PIERCE
Property Tax ID #: 2309-133-0002-000-7
Site Plan Name:
Project Name: STOTZ DCA
1`dtU,_1L_E"b OESCRIPTION OF WORK:'
Place modular building on property for personal use STORAGE
New Electrical Meter existing Second Electrical Meterexisting
Lot No.
IIM.' k .a
CONSTRUCTION -'INFORMATION _
Additional work to be performed under this permit — check all that apply:
—Mechanical _Gas Tank _Gas Piping _Shutters _WindowsJDoors _Pond
_ Electric _ Plumbing , Sprinklers _ Generator „Roof Pitch
Total Sq. Ft of Construction: 8223"
Cost of Construction; $ Jl CS 0
Sq. Ft. of First Floor. 823
Utilities: _Sewer _Septic Building Heights 'n
OWNER/.LESSEE:-... ---CONTRACTOR:..
Name Bemard and Krista Stotz
Name:
Address: 2173 NE Pine Ridge StCompany:
City: Jensen Beach State: _
Address:
Zip Code: 34957 Fax:
City: State:
Phone No, 772-225-1279
Zip Cade: Fax:
E-Mail: kristastotz@hotmail.com
Phone No
Fill in fee simple Title Holder on next page ( if different
E-Mail
from the Owner listed above) �
State or County License
if value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
If value of HAVC as $7,500 nr more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: X Not Applicable
MORTGAGE COMPANY: X Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
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 is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners 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 attornev before commencing work or recording vour Notice of Commencement.
Sign caner/Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF S�%_
COUNTY OF
Sworn to (or affirmed) and subscribed before me of .
Sworn to (or affirmed) and subscribed before me of
enc
' Physical Pree or Online Notarization
Physical Presence or Online Notarization
this � day of 2020 by
this day of . 2020 by
Name of person making statement.0
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identi�tio
Type of Identification
duced L�
Produced
(S n ture of Notary Public State of Florida)
(Signature of Notary Public- State of Florida )
Commission No. "YP"'•.; LASHjP, MINGRAM-RAHMING
Commission No. (Seal)
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N-51 4* EXPIRES; December 20, 2022
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