HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Z ^ �� Permit Number: I-0AD) I - 03d 1
I,___.,. 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
PERMIT TYPE: / J�-
Address: JV I .2t:- 11 C-0y-`l YCA fT V d
Property Tax ID #: S� �� o0� /—� 0
Lot No.
Site Plan Name: Block No.
Project Name:
iitional work to be performed under this permit —check all that apply:
Mechanical _ Gas Tank _ Gas Piping _ Shutters
Electric _ Plumbing _ Sprinklers _ Generator
Sq. Ft of Construction: Sq. Ft. of First Floor: _
of Construction: $ 400 0 Utilities: —Sewer _Septic
Name UU
G�J
Address:
City: F�
State: �L
Zip Code: �
c(�e��
` Fax:
Phone No. 54
G
23/ 04C
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name:
Company:
Address: I
Windows/Doors
Roof Pitch
Building Height:
City: �S1� Stater
Zip Code: �v 1t%S <) Fax:
Phone No
E-Mail
State or County License C t K I' 6 Zd
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.
ESIGNER/ENGINEER:
ame:_
ddress:
_ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
ty: State:
p: Phone
EE SIMPLE TITLE HOLDER: _ Not Applicable
ame:
ddress:
16
Phone:
City: State:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:_
Address:
City:_
Zip:
Phone:
01WNER/ 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
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
;Signature of Owner/ L ssee/Contractor as Agent for Owner
gnature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA j
COUNTY OF q J�o1 o
COUNTY OF hAJ2.LQ__
The IiQrping instr ent was acknowledged before me
The jo,rgoing in ument was acknowledg , before me
2p_ by
this day of 2 by
Il nCl.
thi day o .
Name of person making staterriler5t.
Name of person making statem n .
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
AQ,V, ERL L_��w
fill - —
gn ture of N ,r P"" �dRId RAHMING
S' na re of otary Publi - State of Florid
:.. . , MY COMMISSION # GG 275060
Commission No. LASHAH
C �(p�RAM•RAHMING�o�
# GG 275060
Commission No. `."� e: •EXPIRES:Decewftwo 2
Notary
:•3
b` EXPIRES: December 20, 2022
ru b nd
Public U erwriters
P•
REVIEWS
FRONT
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
ZONING
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
2/7/19