HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO-BE ACCEPTED /n�(} C
Date: Permit,Number: 0kJ '7 ° Dom`'
3..
L Building Permit Application
P,tanning and Development,Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue,Fort:Pierce FL 34982
Phone: (772)462-1553 Fax: (772Y 462-1578
PERMIT APPLICATION FOR:
OR
T
.4
��n ca• .M'....."., .tiy.,aes�arc.. �.•�� � _.. �C:c_ �.,�, a_.. �,-..rx..n� +�tFr1� ..,.:.; =. e. �.n.�,..k Ki;_os a m. ...�t - `.' d.
h
Address:
P ioperty Tax ID#: C a� �d� ' 13" � Lot No.
Site Plan Name: Block No.
Project Name:
W', i•,s'�.x,: �t�•.. '.. '�wt.. _c.. _+n:a .Ya' '„a. �:lx,. �r'"':P }" C -,r,P
Ni w electrical Meter Second Electrical Meter Y
the.i`.�a':`�Tz:irk. £..k�':ar'•v'fW='.+s3..,�, y5.}�'� �.x.'�.k..,� ��•. .r:.�_ ' ��.3� .,1k£���:
z FY � � tt�F; PY � � F� 7V ,,,
1f .5.e s.3�:,a�` .r?S�.n....,� e ns,r,�_ 3 f,.�,.-ua'rn<. 39';L>��rC..+s. �tt: en"�. a"4.Iin..«R;:�h;u �.,6'�X.<�.-4..t Yv>. .Ss 5>t". t.. 35 i
Additional work to be performed under this permit-check all that apply:
^Mechanical —Gas Tank _Gas Piping _Shutters —Windows/Doors _Pond
I
_Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: ' Sq. Ft. of First Floor:
CIost.of Construction:$ Utilities: _Sewer _Septic Building Height:
•'r �' '3'ay''�? ba7 1r'RSi '"'e4„�'_'rP�°�`�.��sru���
��YY{{hh[� ��,.+x n� "::T:7�s:` � '��r�i:`�'�:'! "x,,'_,i 4s� �.�c ti.Z�..`s ih�,••.�»*'a'"��'.2�nYi� , �i�'} � � � � '��.. ,s,x.,� -:�� '-��ct""m i.. .,M�-=��w->e -a
.-}Z,L:�^-..,i„�a.�.`2�'rA.^,:?,.t�3;�',�k,r_t`-'M 6..-.1a..�.+?xr�:�:..,,.'�a xs�>�."; ....�.•'��...,..a:-^�.�:'3'f�hi^'Si'5:.,_...x �`'... ;,r:.w?.�::s�..,...�.�. ,..._ ...1�`�.,: a:'t '+.w,'�.`Y ,�'s,�Si,.."i;�:5a:7_.�4� ��l'3.'�..
Name:-
,,Address: n� Company:
City: 64 -[ -��rt2" State: Address:
Zip Code: ��� � Fax: City: State:
Phone No. -? 7 d-"t-157 7d -5p-S-6 e Zip Code: Fax:
E-Mail: CQ�j2�y-'-ApC d Pill f? yk�k &Wmk Phone No
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.
M
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: =NqfAMpplicao616 lName: 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 ermit_holder t'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.
Inconsideration of the granting of this requested,permit,I do hereby agree that I will,in.alf 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,paying twice for.
improvements to your property: A"-Notice of Commencement must be recorded.�inth-e public.records of St,
Lucie County and posted on the jobsite before the first inspection. If you intend to obtain financing,._consuI ,
with lender or an atton before compQcing work or recording our Notice of Commencement.
Signatu Owner/Lessee/Contractor as.Agent for Owner Signature of Contractor/License Holder .
STATE OF FLORIQ STATE OF FLORIDA
COUNTY OF , COUNTY OF-
Sworn to(or affirmed)a subscribed before me of Sworn to(or affirmed)and subscribed before me of
Physical Presence or Online o arization Physical Presence or Online Notarization
This JL day of- �— 2 by this day of 20_ by'
Na#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-
(Signature of Notary iASH -RAHMING (Signature of Notary Public-State of Florida_,)
s : MY COM SI N#GG 275060
Commission Ni
-•: ;*:
,; f:XPIItE , ber20,2022 Commission No.' (Seal)
9rfpFf�OQ' Bonded Thru Notary Public Underwriters l
REVIEWS FRONT ZONING ' SUPERVISOR PLANS* VEGETATION'' 'SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW ' REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.