HomeMy WebLinkAboutJohnston. Mandy Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ' I 12
. Permit Number:
e C ,;, 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) 462-1S78 CBDG Funding
PERMIT APPLICATION FOR: f l
PROPOSED IMPROVEMENT LOCATION:
Address: 'BCD : LCSe+- 15\-4d . (s—G? IL �-\SkEjc)
Property Tax ID #JW - 1009 �- 0 to 9 - CLAD - T Lot No. �
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Site Plan Name: �'11(Tl _'�T'��e Block No. __.t l
Project Name:
DETAILED DESCRIPTION OF WORK:
K
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit -check all that apply:
)�lylechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors Pond
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
'' ff
Cost of Construction: $ ®`tom , Utilities: —Sewer _Septic Building Height:
OWNERAESSEE:
CONTR OR:
Name
Name:
Address:L11 L-0
Company: -Q k r .I
Address: a nd i'Y e rcla I Ie P1 4 1
City:yin'-k State: V L,
Zip Code:e .)4q`b Q Fax:
City: 1PcY4Sc%AoA- LL-kCState:
Phone No. —"1 - �i01 - `4 �3 E-
f-L_ _
Zip Code: Fax:
Mail• 55
Phone No -7%j -
.,
Fill in fee simple Title Holder on next page (if different
E-Mail ra CV- 3e IrVt C
State J County License
from the Owner listed above)
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:
EER: Not Applica
Name:
Address:
City:
Zip: Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:
State:
— Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY:
Name: _
Address:
City: —
Zip: Phone:
Not Applicable
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 ggranting 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 consu t 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 an ted o he jobsite before the first inspection. If you intend to obtain financing, consult
with lender an atto eyfore Commencing work or recording your Notice of Commencement.
Signature of Ow ntra for as Agent for Owner
STATE OFF OR
COUNTY O
Swor to (or affirm d and subscribed before me of Physical Presence or Online Notarization
this A day of � 20ZZby
Name of person making statement.
Personally Known OR Produced Identification
Typ"f.Identification Produced
(Signature of Notary Public- State of Florida)
Commission No.® 5 1 —7 31 (Seal) NoWy Public SbMs of Florida
Stephanie SpAin
+�,�' My Comrr aim HH 057731
of Expires 1012712024
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION
COUNTER REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
SEA TURTLE I MANGROVE
REVIEW REVIEW