HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED.
ate: 42-zzZo_ Permit Number:
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�. Building Permit Application
Planning and Development Services
i
Building and Code Regulation Division Commercial Residential !�
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578
PERMIT APPLICATION FOR:
Address: 15 I'IA3--c5ric, 4AJAY Fr. pzffGe
Property Tax ID#: 1414 - 7201 - 01?1 -000 S Lot No.
Site Plan Name: Block No.
P oject Name: P94'19PLtTtO�A FcPe—
e, aK1S i 1N t, CA NPtar t> 5LI a 14 4 C.LA gS
F-a '" G1 12-y l j?.l&4-Ct FVIZ pt� Old-sal Z.!t
N+ lectri al Meter Second Elect ical eter
6 oh c • e e &
V fOh Of, h
Additional work to be performed under this permit—check all that appe
Mechanical Gas Tank —Gas Piping —Shutters Windows/Doors Pond
i
— — —
Electric -Plumbing —Sprinklers —Generator —Roof :Pitch
i —
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ �(� Utilities: —Sewer —Septic Building Height:
Name DAVIQS A Wyse- 4m- Name: hl017 r ?eL-4Cs&i3Ud-
:Address: 15' L'tA:5_eSi(L uyQY Company:
City: R. ptI=c2r e. Imo- • State: ICL• Address:
Zip Code: 3'14� 9 Fax: 14/A City: State:
.Phone No. �/3 Zip Code: Fax:
E-Mail: bU®I Wy,4A e— �/90 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 construe on 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.
DESIGNER/ENGINEER: of Applicable MORTGAGE COMPANY: _ Jot Applicable
Name:L-k-)T oM?u Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: J Not Applicable BONDING COMPANY: 1.,<ot Applicable
Name:;�f,At1e_.s ,A. y-f"4 -114e- Name:
Address: CIS i L Address:
City: Ff. QteZX'-e' L - City:
Zip: Phone: a(3�'�- l�l- �5� 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 a'nd'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 a before comr omen' ing work or fecordin our'Notice of Commencement:
Signatu wner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
ST TE OF FLORID STATE OF FLORIDA
COUNTY OF i` A o COUNTY OF
Sworn to (or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of
Physical Pre ce or Online Not rization Physical Presence or Online Notarization
thi -)day of 20C by this day of 20_ by
Name oVperson making staterri4rit. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Pr ced Produced
(Si Ina lure of Notary P ale- "iri#fa (Signature of Notary Public-:State of Florida ).
.�,�»auyG, LASHAHNA NC 'A-RAHMING _
U d MYCO> is ON#GG275060 (Seal)
Commission No. 3I + e Commission No.
� cember 2o,2022
?' •••�oP= PublicUndelwriters
BondedThruNotary
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA-TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW_ REVIEW
DATE
RECEIVED
DATE
COMPLETED
�_ev. 5/6/20