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HomeMy WebLinkAboutBuilding Permit ApplicationIm All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Number: ©� - �f -- Building Permit Application 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 Residential PERMITTYPE: Address: 02 O o �' f �Lf %-e 1,�Jn+�� �J ��`✓-c �6 r T S % • �/� G.�-c Property Tax ID #: Lot No. Site Plan Name: Block No. Project Name: Q C�74 "C ,4T� �, burr r .I Additional work to be performed under this permit -check all that apply: _Mechanical _ Gas Tank _ Gas Piping _ Shutters xef Electric .—Plumbing • _ Sprinklers _ Generator Total Sq. Ft of Construction: Sq. Ft. of First Floor: Cost of Construction: $ l 700 Utilities: —Sewer _Septic Windows/Doors Roof Pitch Building Height: OWNER/LESS E: CONTRACTOR: Name e,AJ Name: Or—' Address:. l ✓,w-t Company: .P -/ City:;.,..:,..../ Stater, Zip Code: " Fax: Phone N'o: = -1`7'=2c= -.i tf,.�-1 :Address--' = �-:C:.-_✓era l�w�t`� City Zip`Cod'e'•.,3.`19':- State:_ E-Mail: Fill in fee simple Title Holder on next page ( if different from the Owner listed above) i E-Mail .'c- G State or County License _��- 13621 - - Alp-5 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. S ERVIRM. RNSWEINNNSM lON LIEN tAW IN DESIGNER/ENGINEER:' Not Applicable Name: MORTGAGE COMPANY: Not Applicable Name: Address: Address: City: State: Zip: Phone 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 permitwill 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 WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." I Signature of wner/ Lessee/Con ractor as Agent for Owner Signature of Contractor/Lic se H der STATE OF FLORIDA STATE OF FLORID%, COUNTY OF COUNTY OF The forgoing instrument was acknowledged before me The rgoing instrument was acknowled ed before me this day of 10• 0 20LOL_ by this day of j'j,, AA by Name of person making statement. Name of person making statement Personally Known OR Produced Identification Personally Known OR Produced Identification Type of Identification Type of Identification Produced Produced lZa L&L,,� (Signature of Notary Publi& State of Flori ) (Signature of Nota u��1 RAF{MING "a�:;; IJIGRAM:RAHMING 1 ^ MY C N G275060 Commission No. : •. LA$ Commission No. "� DI 1t ??20, 2022 i ,' ` * MY COMMISSION # GG 275060 ,; eArRESI :TrF ThN NotaryPublic Underwriters :� • r. yUFF o?,• Bonded •%FOF P :•• Bonded Thru Rai ary Public Underwriters REVIEWS - FRO PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED' DATE COMPLETED Rev. 2/7/ 19