HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: (7� ' 2 w(� Permit Number: V
SM. LUCIE
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Building Permit Application ,flg0epmoot
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Planning and Development Services S . Lucie
Building and Code Regulation Division Commercial Residential X
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
rPROPOSED JMPROVEMENT LOCATION°
Address: 1137 Percival Street, Fort Pierce, FL
Property Tax ID #: 3404-501-0196-000-7
Site Plan Name: Replace damaged wood frame
Project Name: Roof, Truss and wall frame repair
Existing truss was severely damaged by termite. A repair and replacement work is proposed.
New Electrical Meter
Second Electrical Meter
Lot No. 7,8,9
Block No. 38
II Additional work to be performed under this permit — check all that apply: — —
Mechanical Gas Tank Gas Piping Shutters Windows/Doors Pond
Electric _Plumbing _Sprinklers
Total Sq. Ft of Construction: _
Cost of Construction: $ $3,000
Generator Roof Pitch
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic Building Height:
Name Syed Shafeeq UR Rahman
Name:
Address: 805 Virginia Ave, Ste 16
Company:
City: Fort Pierce State: _
Address:
Zip Code: 34982 Fax:
City:
Phone No. -17Z 109 0L10LO
Zip Code:
Phone No
E-Mail
E-Mail:�J��l(10�(1W�'G14� 11�1�rrtG�)�.(,()YY1.
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Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
State or County Licens
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.
Fax:
State:
rGONSTRUCTONLENIALANFORVATIOPPLEMENSUT
a r
DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY: _ Not Applicable
N am e : shahin shafiq
Name:
Address: 7721 NW 16 CT
Address:
City: Pembroke Pines State: FL
City: State:
Zip: 33024 Phone 561-254-4403
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 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 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.
Signa ure of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORID ,�L 1 , 1
I1 �f l��
STATE OF FLORIDA
COUNTY OF
COUNTY OF
Swg,pn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
V Ph sical Pres�gn�cgg o Online Notarization
L�
Physical Presence or Online Notarization
this day of t` 2020 by
this day of , 2020 by
;Dare of person making statement.
Name of person making statement.
,tee
o�
Personally Known Ir OR Produced Identification
Personally Known OR Produced Identification
pe of Identification
Type of Identification
oduced
Produced
tJ
ignature of Notary Public- State of Florida)
MAIRAESCAMILLA
(Signature of Notary Public- State of Florida )
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mission No. (Seal)
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
_
CQM2LETED
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Rev. 5 6 20