HomeMy WebLinkAboutMalik Permit AppAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
I r. LIU, (Z 11, IS
C31 �4' 0 W3, iBuilding Permit Application
Planning and Development Services
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:
PROPOSED IMPROVEMENT LOCATION:
Address: 190 &_Lq bf
Property Tax ID #: aqqL- G4161) 4z' - 0006) Lot No. 2i
Site Plan Name: Block No. W
Project Name: Na1LY_;1R00_(
DETAILED DESCRIPTION OF WORK: t�'a-v- L'(T tfXw"t-19
Uoa, 4 nad, joc(Ae-, remove a 6�lau, octo fasci.. and (hu Jocnde_ _& da-I I
New Electrical Meter Second Electrical Meter
I CONSTRUCTION INFORMATION:
Additional work to be performed under this permit -check all that apply:
—Mechanical — Gas Tank —Gas Piping Shutters Wind /Doors Pond
— Electric — Plumbing Sprinklers — Generator 7ROoof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 1 � Utilities: —Sewer — Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Jy)Y CLV) M
Name:
Address: ep- 15- S'r uu� I
Company:qmda GI R_f dtoyv�
City f, c V_ State:
Zip Code: Fax:
Phone No.
Addre CLt
City: state: Ef
Zip Code: Fax:
Phone No W�P,6
E-Mail:
Fill in fee simple Title Holder on next page if different
from the owner listed above)
E-Mail C7 W/7(e74b5//(" - (_0M
State or County License (al 05) Z0�
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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
Name:
MORTGAGE COMPANY: Not Applicable
Name:
Address:.
Address:
City: State:
Zip: Phone
City: state:
Zip: Phone:
FEE SIMPLE TITLEHOLDER: ____ 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
h lender or an attorney before commencing work or recording our Notice of Commencement.
�•a
gnature of Owner/ Lessee/Contractor as Agent for Owner
ignature Con ractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF__ `,�
COUNTY OF_ ( C�1,
Sworn to (or affirmed) and subscr" d before me of
Physical Pr ence or Online Notarization
this L day of X4 Aw� 2020 by
Sworn or affirmed) and subscribed before me of
- Ph sical Presence or Online Notarization
this day of 2020 by
, '
Name of person making statement.
Personally Known FOR Produced Identification
Tyn entificati'o �' L--
roduced
Name of person making sta�temen .
Personally Known is OR Produced Identification
Type of Identification
Produced
(Signature of Notary Pubcl St
0" Noteiy Public State of
Commission No ;�` jlPamela Jones
g
l r E�Croa 061 5 2 24
pTM4�.
00,
a re of No - t
.►x' Notary Public State of Fl ida
meta Jone&���t�
m ion No, orlisc� a®5470
p� Expires 05115/2024
REVIEWS
FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR
REVIEW
PLANS
REVIEW
VEGETATION
REVIEW
SEA TURTLE
REVIEW
MANGROVE
REVIEW
BATE
RECEIVED
DATE
COMPLETED
Rev. 20