HomeMy WebLinkAboutscanemailsharp@gmail.com_20220324_090526All APPLr _ LE ItY40M�rU�\ST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Z L-�7-lJf Date: O z Permit Number:
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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: N
PROPOSED IMPROVEMENT LOCATION:
Address: 0-1 l�r`( rll4'll I
Property Tax ID#:`�yUi�w' lJ �Z'i�D`
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
Y-'c
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
_Electric _Plumbing _Sprinklers _Generator Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$1 IzoI: W Utilities: _Sewer _Septic
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Building Height:
Pond
Pitch
OWNER/LESSEE:
CONTRACTOR:
Name —OM
Name: 4
Addres�
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Company: i)
i
A/y
City: \ UY I (� (L 12. State: '
Zip Code: iiFa��x1: �l
Phone No.-I-1� V I f -I E-
Addr{,Xs(s: i 1(y Y w # I ZL
City:` V� I ' 4
Zip Code: . Fax`A
Phone No !-?)Ti-- RW
StateAlb—
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Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail(� i1 C 1^ by
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State or County License
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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.
I SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: I
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 I BONDING COMPANY: _Not Applicable
Name:
Address:
City:
Zip: Phone:
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 attorney before commencing work or recording vour Notice of Commencement.
Signature of fontractor- or - Owner Builder as applicable
STATE OF
COUNTY OFORIDA��
Sw44IIQQ o (or affirdz an subscribed before me of _
Physical Presence or _ Online Notarization
thiN day of 1' C U2021by
2c)V),eA Mai c,e�1 e
Name of person making statement.
Personally Known OR P duced Identification
Ty a of Identification Produced U L.0
P
(Signature of Notary Public- State-ofFlorida)
Commission No. 2�1 1 (Seal)
o CATHEr MILLER
Public
g`"tY° State of Florida -Notary
2 Commission#GG 2733is
fv My commission Expires
N ovember al. 2022
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Kev 10/12/21