HomeMy WebLinkAboutBuilding Permit App - Dominic SmithAll APPLICABLE INFO Ml ST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: #14.4aci! _ , 1-02f Permit Number:
U
LUru illl
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
PERMIT APPLICATION FOR
PROPOSED IMPR(
Commercial Residential 'Y'
CBDG Funding
rC-Ah C
ENT LOCATION:
Address JU�a�
Property Tax ID #:
Site Plan Name:.tir�,
Project Name; iwts zL_ Cii,Lr
DETAILED DESCRIPTION OF WORK:
1?a 1A2 -�-
iYJW 4,1-- el- & ,
New Electrical Meter I Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be peeformed under this permit— check all that apply:
(Affidavit required)
Lot No. 2-t-
Block No.-�
W4 f7.- rim
_Mechanical _Gas
rank _
Gas Piping
Shutters _ Windows/Doors Pond
_ Electric
Plumbing
Sprinklers
_ Generator Roof Pitch
Total Sq. Ft of Constructs
n:
Sq. Ft. of First Floor:
Cost of Construction: $
L)
Utilities: _ Sewer _ Septic Building Height:
OWNERAESSEE:
CONTRACTOR:
Name \fh
Name: 6P�-h.,,ct,Lj�- ,('I41,LL q
Address: d.,uas
Company: 19
City:
State: FL.
Address: Is"i AILU Y:riT1_-_?1 Er
Zip Code:.? V 9,0,
Fax: -1 n 'L 4 0.-_'4
a a :
City: Pd,:r -S Lc:c. C State: FL
Phone No. -1-7 2- A,1
-1-7
E-
Zip Code: Fax: 40dii
Mail:
Phone No 71 Ai2ua_z3
Fill in fee simple Title Hollderwn
next page (if different
E-Mail i" F7o lk I
from the Owner listed ab�ve)
State or County License _4� 4;G= i
If value of construction is 2100 or more, a RECORDED Notice of Commencement is required.
If value of HAVC is $7,500 oJ more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL C
DESIGNER/ENGINEEk
Name:
Address:
City:
Zip: Phhp
FEE SIMPLE TITLE H
Name:
Address:
City:
Zip: P
OWNER/ CONTRACTC
I certify that no work or ins
St. Lucie County makes no
which conflicts with any ap
structure. Please consult w
In consideration of the gray
in accordance with the app
The following building pern
accessory structures, swims
WARNING TO OWNER
improveme is to y
Lucie Count and
with lender or ::,n
NSTRUCTION LIEN LAW INFORMATION:
Not Applicable MORTGAGE COMP
ne
Name: ANY
Address:
State: City:
ER: Not Applicable
ne:
Zip: Phone:
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
Not Applicable
State:
NotApplicable
t AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
allation has commenced prior to the issuance of a permit.
Jpresentation that is granting a permit will authorize the permit holder to build the subject structure
licabie Homeowners Association rules, bylaws or and covenants that may restrict or prohibit such h your Homeowners Association and review your deed for any restrictions which may apply.
ing of this requested permit, I do hereby agree that I will, in all respects, perform the work
:)ved plans, the Florida Building Codes and St. Lucie County Amendments.
t applications are exempt from undergoing a full concurrency review: room additions,
ing pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
Your failure to Record a Notice of Commencement may result in paying twice for
►ur property. A Notice of Commencement must be recorded in the public records of St.
sted on the jobsite before the first inspection. If you intend to obtain financing, consult
-.grneV before commencin work or recording our Notice of Commencement.
Signature of ont�to - . r er Bu'r eras applicable
STATE FLORID
COUNTY OF
Sworn toy (or affir ed) anc subscribed before me of
this —day of 1 20ZZby
Name` of person making St itement,
Personally Known ✓ 1OR Produced Identification
Type of Identification,Produced
Physical Preserice or Online Notarization
(Signatur f Notary Publi - State of rids)
Commission No. �i Seal) 4 Notary Public State of Florida
Crystal E CommNayission
G
y Ex Commission 23 829549
Gr Expires 111tK12023
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