HomeMy WebLinkAboutBuilding Permit Application AI CABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
,Date. -ZS "-2� PermitNumber:
Building Permit Application
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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
I
ERMITAPPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION: 1
Address: 3 rid bl r ( S 2 I'/A� d,
Property Tax ID#: 2 Z G'0 1 " 0 7 000 Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED- DESCRIPTION OF WORK:
New Electrical Meter Second Electrical'Meter
CONSTRUCTION-INFORMATION:
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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: Sq. Ft. of First Floor:
to
Cost of Construction: $ �� Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE: ;: CONTRACTOR:
Name 61 pe ti ml cj),-he V' Name: Pci h 8,n e
Address: 3303 Company: PN-e— rlPG r('c- ,Zhc ,
,City: State:=Z- Address: P 0, 90)LJ7-,C)6 S
Zip Code: Fax: City: Ft . f E e r(-f State: F
Phone No. 772- _ J�-32 26 9 Zip
Code: 3 TM Fax:
E-Mail: Phone No , 7 7Z �7— ! - 997
Fill in fee simple Title Holder on next page(if different E-Mail _ �p
'from the Owner listed above) State or County License I1 "ou )6-3
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 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 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 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.
�eOAA �
Ignature of Owner/Lessee/Contractor as Agent for Owner Sign` ure of Contra cf or/License Ide
STATE OF FLORIDA STATE OF FLORIDA
'COUNTY OF COUNTY OFy��
Sworn to(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of
Physical Presence or Online Notarization Physical Pr ce or Online Notarization
'this ,S_day of�� 2020 by th�S day of 2020 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
P duced Pr duced
ign ture of Notary Pub -State of Florida ignat _tFr4i�l
o. 4SHAHNAINGRAM-RAHMING
L�3Hi�HNA IN F MIMING
`'vr'i'sr' � Com m i' ' n k P'IY GCMMISSION GG 27506�$ I)Commission No. CMMISSifJ� �G275060
o= EXPIRES:December 20,2022
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9r �: EXPIRES:December 20,2022 r`9F��°P` Bonded Thru Not.ar Public U
nderwrit—
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
'DATE
COMPLETED
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