HomeMy WebLinkAboutLandis Permit AppI
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date, Permit Number:
0M
Build'ing Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Plerre FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
II
sff
PROPOSED IMPROVEMENT LOCATION -
Address: (a3lO 69Wl 19tC,
Property Tax ID #: 1 �( - (00q - CD 4q - COD + Lot No. 3
Site Plan Name- Block No.
Project Name: L OA&� I&Wa---�-F
[DETAILED DESCRIPTION OF WORK:
i, au Llnadmxk iim oL�
ML (14C of
New Electrical Meter Second Electrical Meter
ICTION INFORMATION:
Additional work to be performed under this permit- check all that apply:
Mechanical Gas Tank ^ Gas Piping Sh utters IWVows ndDoors Pond
ows
Electric Plumbing Sprinklers Generator Root Pitch
Total Sq. Ft of ConstrLiction: Sq. Ft. of First Floor:
1 usE or tonstrucoon, :> - I. I, to LK) Utilities, —Sewer _Septic Building Height:
OWNf-RAESSEE: I
CONTRACTOR:
Name U5-Y3,S
Name: ( i
Address: to A) CAMVwn K4R5
i
Company: moany.,
City. State
Address: ZEn 5'E- G N1 1 Ci-y
Zip Code: Fax:
City: ?-C h I CLe- State:-4
Phone No. (.02-LO8
Zip Code: -ON -5 2. Fax:
E-Mail:
Phone No TtZ (�>21 tO 2
Fill in fee simple Title Holder on next page (if different
E-Mal
from the Owner listed above)
State or County License
IT value of construction 6 z5UU or MOM, a RECORDED Notice of Commencement Is required.
If value of HAVC Is $7,500 or more, a RECORDED Notice of Commencement is required.
rSUPPLEMENTAL
UPPE E M ENTAL �ot
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
ESIGNER/ENGINEbR.Not Applicable MORTGAGE COMPANY;: 77 7ot-400licable
Name: Name: Not Applicable
Address: Address:
City: State: City:
Zip: State —
Phone Zip: Phone:
I
FEE SIMPLE TITLE HOLDER:
Na; ie:
—NotApplicable
BONDING COMPANY. Not Applicable
Name:
Address;
Address:
City:
City:
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT:
I certify that no work or installation has
St. Lucie County makes no representation
which is in conflic t with any applicable
structure. Please consult with your Home
In consideration of the granting of this
in accordance with the approved plans,
The following building permit applications
accessory structures, swimming pools,
WARNING TO OWNER: Your failure
improvements to your property.
Lucie County and posted on the
with lender or an attorney before
Application is hereby made to obtain a permit to do the work and installation as indicated.
commenced prior to the issuance of a permit.
permit will authorize the
that is granting a ermit holder to build the subject structure
Home Owners Association rules, bylaws Or an9covenants that may restrict or prohibit such
owners Association and review your deed for any restrictions which may apply.
requested permit, I do hereby agree that I will, in all respects, perform the work
the Florida Building Codes and St. Lucie County Amendments,
are exempt from undergoing a full concurrency review: room additions,
fences, walls, signs, screen rooms and accessory uses to another non-residential use
to Record a Notice of Commencement may result in paying trice for
A Notice of Commencement must be recorded in the public records of St.
jobsite before the first inspection. If you intend to obtain financing, consult
comrnencin work or recording your Notice of Commencement.
Owner gnature of Owner s e/Contr c
STATE OF FLORIDA
COUNTYOF
Slivoril or affirmed) and subscribed
Physical Prey ncq or — Online
ii—lis ':�day of Aj�j� ,
Ci
rasAgent for Owner
before me of
Notarization
2022- by
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTYOF
Swo o (or affin-ned) and subscribed before me of
Swor 0 rdarayl o
Ph "I
Ph sicalPre-&-�Cpor- Online N 2 1
t
th' day .202
CA -
!Name of person making statement
Personally Known OR Produced
Type cat!
Produ ed FN
Ide ificaitiln
0 'q
00
0 a,
(9 nj
0
-Dr
Name of person makingstatem C -0Z
X�
0)
Personally Known :�ed Identify tim M �2
f
Type of I on
Produced
:0,
61- - w0i
(Signature of Not Public- Sit of Florida
Commission No. q
C 7)
0 Ln-
I—) E
(Se CL Cc E
E, 0
Z 2 WO
(Signature of Not ic- ate f Florida)
Commission No. (Seal)
REVIEWS
FRONT
COUNTER
ZONING
REVIEW
I OR
PLANS
REVIEW
VEGETATION
REVIEW
SEA TURTLE
REVIEW
MANGROVE
REVIEW
RECEIVED
DATE
COMPLETED
Rev, 5;b/213