HomeMy WebLinkAboutPermit App Clarke Install.pdfAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Dates q Permit Number:
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:
PROPOSED IMPROVEMENT LOCATION;
V
Address:3R0a'`i'er-igr-i le✓ HQI Orl ram;v
Property Tax ID #: Lot No.
-Sits-Plan Dame: C, C,4 rIC e ze'sfCA 6n U Block No. (P%
Project Name: (9 ct i-1L f E' I a'p _C'�_
DETAILED DESCRIPTION OF WORK: -
�11 c L I IL e �z I i 1[ _v H-- - In, V I U -h- 1 Ue--
e<1 - (y)-rAe I # (_ I Li Ll
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:
Addit' nal 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. Ft. of First Floor:
Cost of Construction: $ Sj5 C-D Utilities: _ Sewer _ Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name _)C�ttW
Name:�i.lUlYl
Address: 2j2p3?er)a -iY1P Vgfj ICON
Company: TC"Ue _Tem(J L L C
CitY: State:�1
Zip Code:3yG6a Fax:
Phone No. E-
Address: Y8Ze,-5W Y"011(pV
City�_)'5 L_ p� State: F
Zip Code: �Jyct c� vt Fax:
Phone No-77� - %0�- I0-?
E-Mail ' trUt+ern,:� LLC C )CY C_;I' Cmrn
Mail' N1
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
_
State or County License
11 VOIYC ul LuIuuuL Uuti is zauu or more, a ntLUKutu Notice OT LOmmencement Is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLE lNTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: _Not Applicable
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. 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 lerjo r or an attorney before commencing work or recording your Notice of Commencement.
Signature o o a or - or - Owner Builder as applicable
STATE OY ORIDA�
COUNOF
Sworn to (or affirmedand sub cribed before me of
this/ kday
Physical Presence or Online Notarization
of 2Q ,,,,�-by
I
,2l/0 '7
Name of person making statem
Personally Known OR Produced Id e tification�
Type of Identification Produced
(Signature of Notary Public -State Florida)
r..... cA7H'RINEAwEINMAN
Commission NO. (Seal)
.,� Notary Public State of Florida
"�c Commission M GG 239104
�oF
F�• My Comm. Expires Aug 23, 2022
Bonded through National Notary Assn.
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