HomeMy WebLinkAboutWH.permit.app.MossCtAll APPLICA LE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 3 3 L2 Permit Number:
`t, LL_.CJ LiL ,
>= E V r< C L Ary Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Commercial
CBDG Funding
Residential l�
PERMIT APPLICATION FOR: \PiNvCI- -I,1C4. CA
PROPOSED IMPROVEMENT
33 VLOCATION: 14
Address: 61 0 i Q`�� `� y -W-7A `Ti Ck- erce -, r--- 3q-R Op
z
Property Tax ID#:34(C) -S 7-®02.5 -00 --Y
Site Plan Name: T(4 Ga_Oye
Project Name:
DETAILED DESCRIPTION OF WORK:
�SWAWMM
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:
Lot No.
Block No.
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:
pp�
Cost of Construction: $ 1 ) ® 3-2-
Sq. Ft. of First Floor: _
Utilities: —Sewer —Septic
Building Height:
OWNERAESSEE:
CONTRACTOR:
Name ?�'f_
Name: Il 6tir ii t
Address: 6-79n MQ�>S <-_J_ :Jt-%A
Company:.T. NJ" e_ fi1rWbe-4
City: t-t B e4l 4__ State: i.
Zip Code: �4��i2 Fax:
Phone No. E-
Address: I �ilf 5E- Sri klQ-C -
City: TEE '{- 5t L {e-;e State:
Zip Code: -34 O( S;?- Fax:
Phone No _7')-1'-7_ ' �_2 -
E-Mail .i dd 1 1(jby-.avi
State or County License
Mail:
Fill in fee simple Title Holder on next page (if different
from the owner listed above)
11 value of construction is zsuu or more, a K1:LU LJtu Notice of Commencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
Address:
City:
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which conflicts with any applicable Homeowners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Homeowners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
in accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in paying twice for
improvements to your property. A otice of Commencement must be recorded in the public records of St.
Lucie Count and posted on the jo site before the first inspection. If you intend to obtain financing, consult
with der or an attorney befon/commencing work or recording our Notice of Commencement.
Si ature of Contractor 1,6r - ner Builder as applicable
STATE OF FLORIDA
ST. Lcl-te__ czur\ L-
COUNTY OF
/
Sworn t$ (or affirmed) and subscribed before me of Y Physical Presence or Online Notarization
this 3111 day of � jt.t{y'�rt . 20ZZby
� d� lie�
Name of person making s atement.
Personally Known i/ OR Produced Identification
Type ofIdentification Produced
(SignatureU Notary Public- State of Flori
t�`�°�6�., WAYNE C PARKER
Commission No. t\ o1V`L-1cN (Seal) ,��r•` Notary Public -State o' Florida
Commission n H-1 04, 279
;'c�'o
5171
My Comm, Expires Se: 10, 2024
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