HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED (�
Permit Number: Q .
Date:
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial
PERMIT TYPE:.
PROPOSED; IMPROVEMENT LOCATION
Building Permit Application
Residential
Address: (:�CA3 Akac Q adv-A O,C FA Pr2flte (2I 3-11 gq,
Property Tax ID #: 3y � 0 - S 03 - 01-13 - CX-O - S- Lot No.
Site Plan Name:
Project Name:
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit -check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters
_ Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction: 30cp .
Cost of Construction: $ 5
Generator
Sq. Ft. of First Floor:
Block No.
Windows/Doors
!/Roof 5-' Pitch
Utilities: —Sewer _Septic Building Height:
Name Q� f'k?)C(�pL V-1hP,12yr�
Address: (�DCX3 /1- CXQ, I 0(.4
City: eA P"el'ee_ State: FI
Zip Code: ' qqO Z Fax:
Phone No.
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Name: o l� e/ .
Company: a
Address:_/C/73 SJ (e,,"ohO 54
City: 1�r4 S-- 1 Ue t -,P— State: f^(
Zip Code: 3-P}r? Fax:
Phone No-7'7�- ZO c1 �6sr
E-Mail t I ru- ponh✓L , &V-v
State or County License
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEIVINTAL CQNST.,RUCTION LIEN LAW INFORIVI3ATION --:
y
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 is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners 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 YOUR PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WJWYOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT:'
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Signature of Owner/ Lessee/Copt ct r as Agent for Owner
Signature of Contractor/Licen er
STATE OF FLORID4
COUNTY OF
STATE OF FLORIDA
:A
COUNTY OF
The for oing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this( day of mm 20Al by
thisgL day of FAD -%A , 20J�_ by
Name of person making statement.
Name of person making statement. Ll
Personally Known OR Produced Identifications
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
8Z!
ignature of Notary Pub li StaAorida)
( gnature of Notary Public- tate of Florida )
Commission No. - G)RAHMING
Commission No. (Seal)
MY COJAMISSION # GG 275060
r =.• += 0 2022
.:::'' ASHAHNAINGRAM•RAHMING
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MYCOM MISSION #
27 9060
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DATE
RECEIVED
DATE
COMPLETED
ffe—v.2/7/19