HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ,��°`''��
Date: Permit Number:a olo`004s
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
f 2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578
PERMIT APPLICATION FOR:
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Address: / 1-7 CIA k-S
Property Tax ID#: 'S� � Lot No.
Site Plan Name: Block No.
Project Name:
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New Electrical Meter Second Electrical Meter
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Additional work to be performed under this permit—check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors _Pond
Electric _ZJ lumbing _Sprinklers _Generator _Roof Pitch
Total Sq..Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ Z C)o°r Utilities: _Sewer _Septic Building Height:
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:OWNERA L€SSEE<<y a �M � rL, i�� Y'COANTF�A,CTOR,. y�-
Sl c .ra;_ 'i{ <ay., trta _E ai:• .. + e �...,..._.. P �:!
Name MAr Name: 66 f`I n irV-U 1J 1 lE
Address: 79 17 I J I,, a.y Company: S
City: 'O S Q State: F Address: ( /,gl X.-ti
Zip Code: ?`/h $G Fax: City: e c} State:
Phone No. Zip Code: 1 yS�c�/ Fax:
E-Mail: Phone No 7Z- 356 // ZI
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Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License
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.
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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.
i 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
1 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 anot er non-residential use
WARNING TO V�INER:Your failure to Record a Notice of Commencement re I r paying twice for
improve en to our property. A Notice of Commencement must re o ed in the public records of St.
Lucie Co t nd �ost on the jobsite before the first inspection. yo f end to obtain financing, consult
with le er r a at me before commencin work or recordin ou of -ommencement.
Signat r Owner/Lessee/Contractor as Agent for Owner SignXE
o ontractor/License Holder
STAT OF FLORIDA STAF FLORIDA
COUNTY OF COUNTY OF
Sworn to(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of
Physical Pre nc or Online Notarization Physical Presence or Online Notarization
this day of 2020 by this uL day of 2020 by
�:Rka_j l `a
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
(Slgna ure of Notary Publib)State of Florida) (Signature of Notary Public-StA of Florida)
Commission No. a (Seal) Commission No.
,jAHNA ING AHMING
LASHAHNAfNGRAPd fzAHMING $'i-.` _ PJYCOMI44fSS10N#GG275060
.
c, -.r,� �7��: December 20,2022
REVIEWS FRO,'Trr==:.2°L'OI��I� i S:D ci ?��(Jd�R PLANS VEGT4Fl --°� blic VE
COUI ERz,�" luNo ryP 1' 'ters REVIEW REVIEW REVIEW RE
DATE
RECEIVED
DATE
COMPLETED
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