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HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: b 7 Permit Number: 19(DO o `la Planning andi Development Services. Building and. Code Regulation Division . 2300 Virginio� Avenue, Fort Pierce FL 34982 Phone: (772) 462-1553. Fax: (772) 462-1578 Building Permit Application Commercial Residential' PERMIT APPLICATION FOR: �0);�i0A PR®POSED -go RD�MAE�NT LOCATIa : Address: / O7.2 5 3' )Ore r, 0/` i l e,, fe.4 .9estG4 Fz. G.3/ 57 Legal Description: u �T �Li P yam' 7� = �yV 190 Property Tax ID #: '' 4// J//�- 541n01 112 ' 000 ` O Lot No. 2dy Site Plan Name: Block No. Project Name: Setbacks J Front Back: Right Side: Left Side;.. ionai worKto oe perrormea un Mechanical Gas Tank — cnecK a Gas Piping _ Shutters _ Windows/Doors _ Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch Total Sq. Ft of Construction:/z. Sq. Ft. of First Floor: Cost of Construction: $ Utilities: %Sewer _ Septic Building Height: QWNER/LE�S� E : CON> tRALOR: Name 4--n (,t T. GOD 14 Name: eIAP4 X;J-t Address: 57 8ftton Gh . "Comp an Y 'WGM., / i'fJi• 9044t Svc• inC. city: l4'J `Y1GP� State: CT Zip Code: •.19033 Fax: ! Phone N' Address 6�/ '✓ • S�e��r. ock City ' nst i.,.: eGG�' State: GC d ZipCo{r72 32 -.2/?/3�/ Phone No 7 6 72 ' 140 �3 71 E-Mail: Fill in fee simple Title Holder on next page ( if different from the Owner listed above) E-Mail 4el// am .ifi %iy/j i,I G P y4ii o0• Cora State or County License If value of construction is 2500 or more, a RECORDED Notice of Commencement is required. SUPPLEMENTAL CONSTRUCTI©N LiN LAIN 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: City: Address: 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 jobsite before the first inspection. If you intend to obtain financing, consult with lender or- an attorney before commencing work or recording you_ootice of Commencement. Signature of Owner/ Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OF COUNTY OF The forgoing instrument was acknowledged efore me The forgoing in rument was acknowledged before me this � day o 20 l by this day(f 20A by (Name of person acknowledging) (Name of person acknowledging) (Si at r2 of Notary Public- State of Florida) ' natu e of Notary Publ - State of Florid ) Personally Known OR Produced Identification Personally Known OR Produced Identification Type of Identification Type of Identification Produced Produced Commission No. commission fro _ �r _ . _ _ _ ` . Seal) IASIMNAINGRAM-RAHMING t iASHAH NA INGRAM-RAHMING ' MY C Rfiv REVIEWS '' FRONT ?IRE °4IVIi�kGiedTh : December'20 2022 i�tv�k/i6&de�r�rit rs LANS =� b` EXP }ded R e �r 20 a I e 2 t NGROVE COUNTE VIEW VIEW DATE RECEIVED DATE COMPLETED - Rev. //ZU14