HomeMy WebLinkAboutSOUTH EAT POOLS.pdfAll APPLICABLE. INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 3 j100 Permit Number:
S`�L `I'C�L
G > c Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial X Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR:
PROPOSEDIMPROVEMENT LOCATION:
Address: 17,330 Ll; Lo ,
Property Tax ID #: , "' I �LI w.Q - ' I Lot No.
Site Plan Name: Ect4 C[`� 15 � 1J `MS Block No.
Project Name:(��,��"
DETAILED DESCRIPTION OF WORK:
'1
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit -check all that apply:
bWlechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof
Total Sq. Ft of Construction:
-
Cost of Construction: $1'` 3 I l1 c�
Sq. Ft. of First Floor: _
Utilities: _ Sewer a Septic
_ Pond
Building Height:
Pitch
OWNER/LESSEE:
CONTRACTOR:
Name
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+i )//��
-GOLName:
Address: 111100 �J}
City: it P I State: _
Zip Code: N Fax:
Phone No. �( j� ��' '( ���
E-
Company:
Address:
City: P5L ��11
Zip Code: 3Wq S;d Faux:
Phone No '19 i� �J -'6
1 q
State:
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Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail A-*yriq
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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:
Name:
Address:
Citv:
Zip: Phone: _
Not Applicable
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
Not Applicable
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
%okAth lanrJcr nr nn nttnrnAv hofnrp rnmmpnrinu %Arnrk nr rprnrrling vnur Notirp of Commencement.
Signature of C r c or - or - wner Builder as applicable
STATE OF FLO D d ;J
I_
COUNTY OF 44
Sworn to (or affirmed) and subscribed before me of \
Physical Presence or Online Notarization
this—&dayof ^()k:]CC h 20,a)by
--T ?,rA l
Name of person making statement.
Personall nown _ (� OR Produced Identification
Type of Id ntification Produced
l (�f U0JO avAle-)
2,_Ow
blic- State of Florida)
(Sign of Notary PuCY
;e"A PU,
SANDRAMARIE GALLWAY
Commission No. "I (Seal) , *
Commission # GG 347510
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Expires June 23, 2023
rF�FP1.�! EonWThruBudget Notary Union
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