HomeMy WebLinkAboutScan_2022-03-03-130358735.pdfAll APPLICA LE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: i Permit Number:
r. DOME
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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:Ov
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Address Lan
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Property Tax ID #: ol�C.�° Lot No.
Site Plan Name: Block No.
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Project Name:
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New Electrical Meter Second Electrical Meter (Affidavit required)
RAIN I - -
MIMI
Additional work to be performed under this permit — check all that apply:
Gas Tank Gas Piping ^ Shutters _ Windows/Doors _ Pond
_Mechanical _ _
I
Electric _ Plumbing _ Sprinklers _ Generator_ Roof 12— Pitch
Total Sq. Ft of Construction: l Sq. Ft. of First Floor:
Cost of Construction: $ `� 1 0 Utilities: —Sewer _Septic Building Height: G
. Name 4a tAddrCompany:
NamTss�c4,
Address:Flo 1 � C-(� `� ilk
lsY1St e.
City: ,
City. State �—
Zip Code: a 1 Fax:
Phone No. E-
Zip Code:34 z Fax:
Phone No ��I'.�2i
Mail:
Fill in fee simple Title Holder on next page (if different
E-Mail r tri 11ic, CP q'�Gi 6 GJ
from the Owner listed above)
State or County Licens 135
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.
AMIN
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: — Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City:
Zip: Phone:
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 County and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
...;" 1.... d�+i-knfr%ra rnmmanrino wnrlr nr rerorcling your Notice of Commencement.
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Sign ture ontractor - or - Owner Builder as applicable
STATE OF FLORIDA
�"
COUNTY OF
Swor to (or affirmed and su scribed before me of
Physical Presence or Online Notarization
this i7 day of iJ, 20a,�kby
f.. ayjE)t rn ,Do s �
Name of person m king statement.
Personally Known OR Prgdt{c� Iidee,tip fjcation
Type of Identificati R uced
M`
(Signature of Notary lic- State of Florida)
Kenny Hanzow
Commission No. (Seal)
Notary Public
*40
State ofFlorida
Comm# HH087667
Expires 2/1/2025
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Rev 1u/12/11