HomeMy WebLinkAboutDUGAS PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: .Z�/ '7 �.2Y- Permit Number:
G' G LU v2L'
V
-• Building pp 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
PERMIT APPLICATION FOR:
Residential
PROPOSED IMPROVEMENT LOCATION:
Address: ✓ 6--7-- /V U � S x-e-0 1 /3/:2- 11, /7 I--,-1 F% ff V q9c�
Property Tax ID #: Lot No.
Site Plan Name: �•� ' i' �rt��Block No.
Project Name: D (k ( ,�
DETAILED DESCRIPTION OF WORK:
-- 0 �0 /V
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
_ Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $
_ Generator
Sq. Ft. of First Floor:
Windows/Doors Pond
Roof Pitch
Utilities: _ Sewer _ Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name &---I 4
Name:
"'1 S
Address: MIS
Company: V_d�
City: l State: �
Address:
Zip Code:,- J q 9>0 Fax:
City: ( 2,2t /`', ern
8z 0_r, State:
Phone No. (,i 7- <2,5-y- q1
Zip Code: Z7
-El -
Fax:
E-Mail: i rt CIL' t_or t'j / C_O4�. C eye' )
Phone No .5
qV — (a s"l o
Fill in fee simple Title Holder on next page ( if different
E-Mail �t"a'C� J.1
�)
from the Owner listed above)
State or County License
6t-/�J/�,
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:
DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
Name:
Address:
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 is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners 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 'obsite before the first inspection. If you intend to obtain financing, consult
with lenderW an attorney be "ommencing work oy recording our Notice of Commencement.
---------------
Signature of Owner/ Less ontractor as Agent for Ow
`e
STATE OF FLORIDA/
COUNTY OF
and subscribed before e of Physical Presence or Online Notarization
Sworn to (or affirM2LcL0'-,J
this day of20--."- y
Name of person making statement.
Personally Known �_ OR Produced Identification
Type of Identification Produced
(Signature of Notary Public- State of F on la )
�~�T; ." r 1 �PRYq PAMELA A. KEPHART'
Commission No. �� l / �c (Seal) sso�, NOTARY PUBLIC
G�°
STATE OF" FLORIDA
y` A- Comm# GG211428
.s1NCe IS1 Expires 4/25/2022
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