HomeMy WebLinkAboutBuilding Permit Application - Pershing MH SalesAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: q17
Permit Number:
9VI LL EYCE18
0
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 C13DG Funding
PERMIT APPLICATION FOR: (L
P
00
Address: Po'nc't
Property Tax lD#: oQJ63 -9-11 -o62 .. Lot No.
Site Plan Name:
Project Name:
fs ,A 1z6"'4 � "4 P- � f P0J v 0 o- 0 L) -e (L-
(�
fs a ;1d (-' a a- p 0 r?_�- 16, x a,
NewElectrical Meter Second Electrical Meter.
Additional work to be performed under this permit- check all that apply:
(Affidavit required)
Block No.
Mechanical Gas Tank Gas Piping Shutters Windows/Doors Pond
Electric Plumbing Sprinklers Generator Roof Pitch
Total Sq. Ft of Construction:
Cost of Construction: $ _. �?,6 ? 0 6
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic Building Height:
Name Xty 0_44,e- P6 02 ',Q a (4 Cl
Address:
City: r-4- P; e g &-k State: L/
Zip Code: Fax:
Name: (Y'XCA_QJe_C -
Company: fJ2_5'-k t7 an 6: 0%(A 9A
Address: cl i 3
City: Fa a-.+ State: r)
Phone No. 4/ 6,5'- - ?Q 0 6-- E- Zip Code: 3Q ry &9- Fax:
Mail: Phone No '7;;) -61 e-'e-1
Fill in fee simple Title Holder on next page (if different E-Mail e_arl_i� a bN c, &dJ&zL&2a
from the Owner listed above) State or County License— c9 e-1 5'.-2
if value of construction is 2500 or more, a RECORDED Notice oT Lommenrement is iMmull Cu.
if value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
Name: Foo2'jr, Q_
Address: S Lot R_
City: 'To—vv% jQ c�. State: —�
Zip: 33(�6c1Phone13��iG!®G��
FEE SIMPLE TITLE HOLDER: Not Applicable
Name: PQ V_,- .; kL� M AID' I �e. Oowi .fe e SaT
Address: 90 I ivuo a I S* r3 u�
City: h -
Zip° a-,3n&J Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:
Address:
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
with lender or an attornev before commencine work or recording our Notice of Commencement.
Vk
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF S7 L octE
Sworn to (or affirmed) and subscribed before me of ✓Physical Presence or Online Notarization
this 7K day of At-411LCU .20 22 by
MA?TI�FEf~J A�1/�lC�
Name of person making statement.
Personally Known !� OR Produced Identification
Type of Identification Produced
604.'�
(Signature of Notary Public- State of Florida)
RUTH HOLMAN
Commission No. GG 9 7.?4 �° (Seal) NOTARY PUBLIC
STATE OF FLORIDA
$ElOrt;
Comm# GG973640
Expires 3/26/2024
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Rev 5/ZU/Z1