HomeMy WebLinkAboutWH.permit.app.MossCt All APPLICA LE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 3 77 LZ Permit Number:
S t, LL�L�
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: \PJNVCL [+ "C I,1 C)u -
PROPOSED IMPROVEMENT LOCATION: 14
Address: 61g0 iMQ`::,�-, 64-, , -W_7A -Ps e_., `I'I-- 3 L6 S'Z
Property Tax ID#:34(C) -SU] -002.5 -00 -"-Y Lot No.
Site Plan Name: TRO e(Z-Oye e_01JD0tA 1 I'.dl o M Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
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 _Windows/Doors _Pond
_Electric /Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq.
Sq. Ft. of First Floor:
®Cost of Construction: $ I ) 00
Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Imo —i of' Ssot1f ,n sn n Name: MnAr
Address: 6-790 Mo�>S CT` A---7A Company:. NJUA luvwhe.4-
City: EDc-tB64 e- - State:��. Address: I�i '5G- S_ & Ijr
Zip Code:�4 �Z Fax: City: P&T";+ t {r, State:
Phone No. E- Zip Code:-34 0( S;2� Fax:
Mail: Phone No -7'7 73 '7- �-
Fill in fee simple Title Holder on next page(if different E-Mail
from the owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
If value of HAVC is$7,500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
OWNER/CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which conflicts with any applicable Homeowners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Homeowners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
in accordance with the approved plans,the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review:room additions,
accessory structures,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use
WARNING TO OWNER:Your failure to Record a Notice of Commencement may result in paying twice for
improvements to your property./Aotice of Commencement must be recorded in the public records of St.
Lucie Count and posted on the jite before the first inspection. If you intend to obtain financing, consult
with der or an atto ne beformmencin work or recording our Notice of Commencement.
Si ature of Contractor 1,6r ner Builder as applicable
STATE OF FLORIDA
COUNTY OF ST. LiIG4L° ttif /
Sworn t$(or affirmed)and subscribed before me of Y Physical Presence or Online Notarization
this 3111 day of 12027 by
"r) i0l&4 tZ4-
Name of person making s atement.
Personally Known i/ OR Produced Identification
Type of Identification Produced
(SignatureU Notary Public-State of Flori
t�`�°�6�., WAYNE C PARKER
Commission No.'dk W 't lc1 (Seal) Notary Public-State o<<iorida
Commission n HH 0??279
My Comm,Expires Se:10,2024
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 10112121