HomeMy WebLinkAbout8301 S Indian River Dr. - Permit App.pdfAll APPLICABLE I FO MUS BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date / Permit Number:
LucLL
W � .J r _
L 0 ° - Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR: C. /
Residential
PROPOSED IMPROVEMENT LOCATION:
Address: / X. Zdijom, e .
Property Tax ID N: .3D/X- - yy Z -( ooz - 2 _ _ Lot No.
Site Plan Name: Block No,
Project Name: _
LD TAILED DESCRIPTION OF WORK:
LAP G&4d L r. - k
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:'_
Additional work to be performed under this permlt - check all that apply:
_Mechanical — Gas Tank Gas Piping _ Shutters _ Windows/Doors _ Pond
iectric — Plumbing — Sprinklers — Generator _ Roof Pitch
Total Sq. Ft of Construction:
Cost of Construction: S 0c,
Sq. Ft. of First Floor:
IltilitirS: Sewer _Septic Building Height:
OWNER/LESSEE:--
Narn
Address: S' 1 f A Al ki
_ r
City: T)oj i testate: LL
Zip Code: 2Y M2- Jaw
Phone No. Y 92 /(r rr _ E-
Mail: .,CLAft c . V 'iLa ems, NIT
Fill In fee simple Title Holder on newt p ge (if different
from the Owner listed above)
CONTRACTOR:
/s
Company: Ire /tk tk k .i/itcTit�
Address: flit % X
City: 14416 state: f�
Zap Code: _ Fax: 1IL1ZE2—f—
Phone No 2 /'e
E•MailD91 4k4 J600 & ALS
State or County I irense_9C ? 00 C21 e
It value of construction Is 2500 or more, a RECORDED Notice of Commencement Is required.
11 value of HAVC Is $7,500 or more, a RECORDED Notice of Commencement Is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
IGNER/ENGINEER:
Name:
Address:
City:
Zip: Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone: _
— Not App
State
MORTGAGE COMPANY
Name:
Address:
City:
Zip: Phone:
Not Applicable
State:
Not Applicable f BONDING COMPANY: _Not Applicable
Name:
Address:
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 Coupty and po ed oryhe jobsite before the first inspection. If you intend to obtain financing, consult
with le a or an t rnev efore commencing work or recording your Notice of Commencement.
Sigq6tu>Kof Contra[for - or - p er Builder as applicable
r Pill,
Notary=SawVer
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JennifSTATE
OF FLORIDA
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r_tycoCOUNTYOF
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Sworp�Q (or affir lj�ed) and subscribed before me of � Physical Presence or Online
:day 2CG5 by
Notarization
this of
Name of person making statement.
Personally Known OR ProdlAced Identification
Type of entificatfon Produ d�, „
i�
(Signature Notary IbIVItate of FI r da)
Commissio o (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 10/12/21