HomeMy WebLinkAboutFarrellAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 3 - C9 - as Permit Number:
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) 462-1578 CBDG Funding
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: % 5 y N� /lam% (S UTTO LLLS 0 �-� L ( K
Property Tax ID #: l-t qa - ��qo -Oco & -Q�o -a Lot No. _
Site Plan Name: 14AIMC Z JK ID6 E-_- lRIZIEE_Tgllou)0ZVII L LoT�_ Block No.
Project Name: FA Z R E
DETAILED DESCRIPTION OF WORK:
C I
New Electrical Meter �%_ Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:
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: ly I� Sq. Ft. of First Floor:
Cost of Construction: $ c - y00 Utilities: _ Sewer _ Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name ��vi�D PS) MNR Z (_
Address: (.J I�u pv\ us
Name: N
D
Company: f� �%� �/e�7
� (d �tiL
City: EmV\-,\ C° I l y State:
Zip Code: 3 J I Q Fax:
7 � � 3 b - 3 �-( D
Phone No. ? E-
Address: /�
N
City: �CeySC�� � r �N �^
Zip Code: Fax:
Phone No :2 % 2 I-(
state:
St -%
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail 1 tJ 60 N
State or County License °L 1 3 OD 6 s-64
_ _ _ __..__. ___._..._�, a 11�...n000 ,,,Duce vl wmmencemeni is requireo.
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
MORTGAGE COMPANY:
Not Applicable
Name:
Name:
nuu Tess:
Address:
City:
State:
City:
State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
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 conflicts with any applicable Homeowners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult wit 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 and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
with lender or an attorney before commencing work or recording vour Notice of Commencement.
gna ur of Contractor - or - Owne uilder as applicable
STATE OF FLO
COUNTY OF �aril r J
Sworrtto (or affirmed) and subscribed before me of x
Physical Presence or Online Notarization
this,Z aday of f�'1A'PC H 2022 by
L L SIN C LF i CIS
Name of person making statement.
Personally Known X OR Produced Identification
Type f Identification Produced Fo �7 �-
�-�-�-�.c��
(Signature of Notary Public- State of Florida)
A°m KRISTINA MATHISON
o
Commission No. Seal) _
Notary Public, State of Florida
Commission# GG 913030
My comm. expires Sep. 28.2023
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