HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO*MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED /
Date: 1" Permit Number: X%rl � l5"o-L
•
Building.Permit Application
Planning ond'DevelopmentServices
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (712)462-1578
PERMIT APPLICATION FOR: A�C�
PROPOSEr.D IMPROVEMENT L_O ATION:
Address:� 0, Utz � �W�k,
Property Tax I0'#:45bl-5c)\ -(aal l'�4®'3 Lot No.
;Site Plan Name: Block No.
Project Name:
DETAILED.DESCRIPTION'OF WORK:
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Addit' l work to be performed under this permit-check all that apply:
_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:
OWN ER%LESS E: CONTRACTOR:
Name k"Mc, `z_er0.v5 Name: ' -
Address: V%3 Company:
city:' State: "�- Addr s:R'Z6 S V1S Y'
Zip Cr el odef Fax: City: %UACI State:
Phone No. ft- Zip Code: '13 Fax:
E-Mail: N Phone No r1Lk
Fill in fee simple Title Holder on next page(if different E-Mail C1,jV,M a
from the Owner listed above) State or County Licenser\% R R,Q _
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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
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 cori kt 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.
1 The following building permit applications are exempt from undergoing a full concurrency review:room additions,
accessory structures,swimming pools,fences,wails,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 property.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 financing,consult
with lender or an attorney before commencing work or recording our Notice of Commencement.
z
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA ` STATE OF FLORID ,
COUNTY OF 1ua e+tfb. COUNTY OF
Sworn to(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of
Physical Pr ence or Online Notarization Physical Prep nce or Online Notarization
thip, day of 20�Q by this�day of 20� by
�— aT Ols�,—
Name of peribn making statement. Name of person making statement.
Personally Known OR Produced Identificationv .Personally Known OR Produced Identification v
Type of Identification Type of Identification
Produced - Produced
(Signature of Notary (Signature-or N a8utui�Srate of Florida)
`A"`•`' AHNA ING
< `e.•.p e�; LASH RAM- rYi±,•., '
,;:• RAHMING I:;y•• • LASHAHNAING
e_�; - ;* My com MING
Commission No. (J�bl(uN#GG 275060 Commission No MMISSIQN r
EXPIRES:December 20,2022 %�060
••lac P •e;
Bonded Thru to €J ;For F�oP,. EXPIRES:December 20,2022
Lary Public Und
u le n er"ters
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE ROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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