HomeMy WebLinkAboutHumayun Shareef Permit ApplicationAll APPLICABLE INFO' MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: A . 2l 3tQT-( Permit Dumber:
Building.Permit Application
Planning and DevelaprnentServices
Building and Code Regulation Divlslon Commercial Residential ✓
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
l3 Uu S
PROPOSED IMPROVEMENT
LOC�ATION: r�
Address: "WrL So.'oow t..xeC! ]� lw-. t�Ol2T :S�r. uk_f. - , r L ZC4 g�_
Property Tax ID#: 33A1- 5 2- DOib Lot No.
Site Plan Name: J A Block No.
Project Name: S14 A✓LEFEE ,
DETAILED .DESCRIPTIOYN OE WORK:
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional 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: 1 LP 7C 11
Cost of Construction:
Sq. Ft. of First'Floor:
Utilities: Sewer —Septic Building Height:
OWNER/LESSEE:
CONTRACTOR.,
Name
Name:
Company: - Ot Ao T
1 _
Address: �SS�tZ S ��a }ri l �T-. _
City:)?,�'. L'UCW_ -State:
Address. 3'755''L5t-AL gZ'I _!f2 D#'k�
Zip Code:CIC(p Fax:
Citytiyi taP.J� 'iLLI- Stater
Phone No. 'i: D' 2D QA
Zip Code: 'b3Y 1) Fax:
E-Mail:
Phone No I-IrItXD
Fill in fee simple Title Holder on next page ( if different
E-MaiC.Ju
from the Owner listed above)
State or County Lice rise
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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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 conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consultwith your Home Owners Associationand reviewyour 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.
1
Signature a wner/ Lessee/Contractor as Agent for Owner
Signaturo Contractor/License Holder
STATE OF FLORID]
STATE OF FLORI
COUNTY OF 1 ALWL e"
COUNTY OF_jkana 4G
Sworn to (or affirmed) and subscEjlaad before me of
Physical Presence Online Notarization
Sworn to (or affirmed) and subs ribed before me of
or
Physical Presence or / Online Notarization
thisw-
ALday of —_V?D,k3uiA i9,4, 20,Q[ by
thEtR I day ai�c. �t�1472c! 20Z by
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
Pr duce d
Produced
(Signature of Notary Public- Sta . a racy L Scariott
(5i$ ature of Notary Public- 5tat of�da��a )Notary Public State of r{
My Commission GG 3430
Commission No. 3�i`'JO co Segrfires OW0912023
_ l '1
8 Tracy L Scarlott
C ission No �/'� ' c ommission GG 343
0810$)2023
�*Expres
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SETA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. o/b/71u