HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED '2
Date: 1' �"\ Permit Number: �
I
uo ILUO RECEIVED
O
° Building Permit Application MAR 1 1 1021
Planning and Development Services Permitting Department
Building and Code Regulation Division Commercial i_� Residential 9t, Lucie County
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462=1578 Ak r%. r ^
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address:
PropertyTaxlD#: �3b���`5-Oa1q— QC3a'� Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION'' OF 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: Sq. Ft. of First Floor:
Cost,of Construction: $ ® Utilities: —Sewer Septic Building Height:
OWNER/LESSEE: :.
.CONTRACTOR: .
Name
Name: Spy 'lUS �k4ynAin
fJ7,C;v1
Address: ` QL ti L '�-�3 t5
Company �� L131�
�1� Cbi �
City: 1' �°t5 StateC ,
Address: ly • �C�
1�'I �5 2.
City: P CA I CE
State:_93
Zip Code: � 3 S Fax:
Phone No. - )2-- Le`i
Zip Code::��Aq"�) Fax:
Phone No '7-i2 22& "
kl:2,tcs�;
E-Mail: R]L-)jW
Fill in fee simpleitTle Holder on next page (if different
E-Mail er 0\ 1 a\ Cow
O�b'1C��1 k , A
from the Owner listed above)
State or County License QlC�!!C,
06on , lQ
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 ,CONSTRUCTIONL , IEN LAW INFORMATION
5 Y s
DESIGNER/ENGINEER: Not Applicable
Name:
Address:
City: State:
Zip: Phone
MORTGAGE COMPANY: _.No
Name:
Address:
City:
Zip: Phone:
Applicable
I State:
I
FEE SIMPLE TITLE HOLDER: — Not Applicable
Name:
Address: w `.
BONDING COMPANY: Not
Name:_
Address:
ffyo
Phone:
Applicable
City: "' ,�' �. i o` ;�'+
Zip: Phone`: - yip€"
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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 r@e diry�y�our Notice of Commei1c',ement.
of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF
SwoVn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this day of 20.20 by
Name of person making statement.
Personally Known OR Produced Identification
Type of Ideatification,r
Produced /= OL. % 2.60_ 7AL 6 ,26J -D
(Signatu of ry Pu T
Ti �eA HUSSA7
IN
Commission No. EXPIR03:`1 rit09 20249
Contractor/License Holder
STATE OF FLORIDA COUNTY OF L
Swor o (or affirmed) and subscribed before me of
Physical Presence or Online Notarizatio
this day of n2020 by
Name of person making statement.
Personally Known OR Produced Identification I/
Type of Ideytification
Produced ff _Z 4 D vc—'a CI�Z_ 3i(,_ 2k8 O
(SignaturftWotbry Public- g
at q Frp"ridbr j—""'
� SLAM M. HUSSAIN
MY C f 010N # GG961059
Commission No. � ' =. ApriY09, 2024
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