HomeMy WebLinkAboutDallas Gory.pdfAll APPLICABLE INFO MUST 13E COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
O
p , • - { 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:
Address:
Property Tax ID #:
Lot No.
Site Plan Name: 06 Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
(Affidavit required)
Additional work to be performed under this permit -check all that apply:
_Mechanical Gas Tank
— Electric � lumbing
Total Sq. Ft of Construction:
Cost of Construction: $
OWNER/LESSEE:
Gas Piping
— Sprinklers
Shutters
_ Generator
Sq. Ft. of First Floor;
Windows/Doors Pond
Roof Pitch
Utilities: _Sewer _ Septic
Narr�e ' fi
Address:
City: n 2, ot w— - State:
Zip Code: Fax:
Phone No. C S- E-
mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
CONTRACTOR:
Building Height:
Name:11,
hu
Company: 1
Address: , 5 Ll ar,�c:, I
City:'A6e r12- jC'13�_ _ State:
Zip Code: 2 Fax: '"
Phone No
E-Mail()r`P . viIt,-,,,.,eki&,�nna�.,..,tioa , z
State or County
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" r+rnvvII 1: 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 far
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
WI)ith fender an Iattorne before Commencing work or recording our Notice of Commencement.
c R
Contractor - or -owner Builder as applicable
STATE OF FLORIDIA
COUNTY OF
Sw4n, �Q (or affir ed) and subscribed before me of Physical Presence or Online Notarization
thisd`•-'I day of
�c (- Y--\ zIQ-&by
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification Produced
(Signafure of rotary Public- State of Florida)
Commission No. (Seal)
REVIEWS I FRONT
COUNTER
DATE
RECEIVED
DATE
COMPLETED
ZONING
REVIEW
APR#L RENEE CARINI
_��Notary Public - State of Florida
Q Commission # HH 1538"
'�?o�fl°' My Comm. Expires Jul 20, 2025
Bonded through National Notary Assn.
SUPERVISOR PLANS I VEGETATION SEA TURTLE MANGROVE
REVIEW I REVIEW REVIEW REVIEW REVIEW