HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED C
Date: 3/ 2 5/ 2 2 Permit Number: d G Z
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Building Permit Application
Planning and Development Services MAR 3 12022
Building and Code Regulation Division Commercial Residential St,� 'e
2300 Virginia Avenue, Fort Pierce 0 34982 Permitting
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: 7504
Property Tax ID #:
Site Plan Name:
Project Name:
1301-602-0079-000-9
DETAILED DESCRIPTION OF WORK:
New Electrical Meter
Second Electrical Meter
CONSTRUCTION -INFORMATION:
F1
RECEIVED
Partial LR No12
Block No.
(Affidavit required)
Additional 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: $ _ 11 , 8 6 2.0 0 Utilities: —Sewer —Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR: -
Name lnani P1 Ni nPdorf
Name: Chris Milliman
Address: 7805 Eden Rd. _ _ _ _ _ _
Company: Window Sales & Service of Ver
Address: 775 90th Ave.
City: Ft. Pierce State: Fl
Zip Code: 34951 Fax:
City:Vero Beach State: F1.
Phone No. 772-21 6-4747 E-
Zip Code:32968 Fax:
Mail: ninedorf@bellsouth.net
Phone No 772-567-31 25
Fill in fee simple Title Holder on next page (if different
E-Mail wi ndc)wsa 1_es (ab 1 1 so h -net
from the Owner listed above)
State or County License 22-00028461
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.
-SUF,P.,L"EMENTAL 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: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
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 lender or an attorney before commencin work or recordine vour Notice of Commencement.
Signature of Contractor - or - Owner Builder as applicable
STATE OF FLORIDA
COUNTY OF -�Vn d tQr) Fil V2r2—
Sworn to (or affirmed) and subscribed before me of �ical Presence or Online Notarization
this a,S dayofctrc_E+ 202Zby
f
l� ►N 0 5 fA rrla ✓-1
Name of person making statement.
Personally Known ✓OR Produced Identification
Type of Identification Produced
e"H_
(Signature of Notary Public- State of Florida) Ye CARMEN BEDELL
.:
=¢ *, Commission # GG 223441
Commission No. (Seal) Expires Jul15,2022
Bonded Thru Trov Fain Insurance 800-385-7019
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