HomeMy WebLinkAboutBuilding Permit All APPLICABLE INFO MUST-BE.COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit.Number: Alunoo ahm'aS
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Building Permit Application
Planning and DevelopmentServices
Building and Code Regulation Division Commercial Residential 1�
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578
PERMIT APPLICATION FOR:
Address: "o OF Wrc V-P,:!:Y `7x- i`e (,,L 3yCgz
Property Tax ID#: YO`4 (a a Z-a7 00b D Lot No.
Site Plan Name: ;4-6 Block No.' b
Project Name:
.. Rug
(j)IJ / 1720 _L-IF 6 FI me. el
New electrical Meter Second Electrical Meter
Additional work to be per-formed under this permit-check all that apply:
P
_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:$ Utilities: —Sewer _Septic Building Height:
�.;n„_ -sxs-.-..,g..•.-. - .1:��Y x. „`3::""`_�+-c. ,� -x �.�z�- �,s' ..,n---c,� y"`tcY.yY e :q }-�y...���: i��..�.�:.�•O.t"�C. ��,r.�,o�� G _
Name. S_U c$;-�Y� �-rse. Name: 4t--1 52
Address: S '7)'-1 V e�( 4 &:r 0-f-f- Company:
City:; 'PT- 5-r Luci-e State: �^' _ Address: S YAQ )-ywtSUw►e-
Zip 3`��} �Z Fax: City: f -f�'c- State:_ -��
Phone No. 77 Z..- 2v! -77 2"T Zip Code: 34 Fax: `77L'��S` Z` -73
E-Mail: Phone No -7-72— I :7
Fill in feesimple Title Holder on next page (if different E-Mail
from the Owner listed above) = State,or County License 'Pj D qdi) 36 Lf
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.
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:-
City:
ddress:City: State: City; V State:
Zip: Phone Zip: Phone:
FEE SiMPLE TITLE HOLDER: Not Applicable . BONDING COMPANY: —Not Applicable
Name: Name:
Address: I A A Address:
City: City
/V
Zip: Phone: Zip: Phone:
OWNER/CONTRACTOR AFFIDVAT:Application.is hereby made to obtain a permit to-do the work and installation as indicated.
A 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 holderto build the subject structure
-which is in conflict with any applicable Home Owners Assocratlon rules,bylaws or and covenants that may restrict or prohibit such
structure.Please consultwrth,your Home Owners Association and reviewyour deed far any restrictions which may apply.
In consideration of the granting of this requested permit;l 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,
accessorystructures,swimming pools;fences,.walis,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 properb/. 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 riancing, consult
With lender or an attome efore commencing work or recordiri . ou No ' e of_Cqmcement.
12 .....-
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder .
STATE OF FLORIDA. STATE OF FLORIDA
COUNTY.OF �- �.,V�; _ COUNTY OF 5d'
Sworn to(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of
,Physical Presence or Oniine Notarization. Physical Presence or Online Notarization
this�' day of 20 by thisay of 20 by
Name of person making statement_ Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification �-'�—
Type of IdentificatLoo Type of Identificatio
Produced oduced .k, u
Signature of Notary Publi to of Florida}. U_ °r X 1griat re of Notary Public-Sta f Florida) ac o c� N
M w c�
no� c _ Ixl� Go
Commission No. (Seal) m 6 ;° mmission No. ,(Seal) oc� _•�
w W o 2 E m
oy Noa
._ Cn
REVIEWS FRONT ZONING SUP )J " LANS VEGETATION SEA TURTLE aV
COUNTER REVIEW R fW u' iEW REVIEW REVIEW E IF,U
DATE
RECEIVED
DATE
��i�N r Sip
COMPLETED
Rev.5/6720