HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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p a o n o p Building Permit Application
Planning and Development Services
j 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:
oq Wi nie r C,50C Pn PK"
Property Tax ID#: 130 k' L.013 — 00M - W0- c0 Lot No.
Site Plan Name: Block No. ��SZ
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:
Address: Company:
City: State:PL Address:
Zip Code: Fax: City: State:
Phone No. e _05 Zip Code: Fax:
I E-Mail: h k O[JrMi , '1 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 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 indiFated.
I ceofy that no work or installation has commenced prior to the issuance of a permit.
St. L'cie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
whic�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
lin accordance with the approved plans,the Florida Building Codes and St.Lucie County Amendments.
I
IThe 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
WA KING TO OWNER:Your failure to Record a Notice of Commencement may result in paying twice for
m rovements to ourproperty. A Notice of Commencement must be recorded in the public records of St.
u ie County and your
o th jobsite b re the first inspection. If yop intend to obtai financing, consult
Notice of Commencement.
it lender a attorneyncin work or recordingyourNo ce
Si ature of Owner/Lessee/Contractor a ent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
prn to(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of
Physical Presence or Online Notarization Physical Presence or Online Notarization
thi$ l'1 day of `m9&x�), 12026 by this day of 2020 by
I
I
Name o person making statement. �� Name of person making statement.
Personally Known OR Produced Identification �° Personally Known OR Produced Identification
Type of Identification Type of Identification
duced Produced
� o
(Sid ature of Notary Pu.: ic-:_State Qf El.o s (Signature of Notary Public-State of Florida)
LASH,A HNA INGRAWRAHMING
Commission No. _N :.n ,� r.jyCOA#A'ON#GG275060 Commission No. (Seal)
EXPIRES:December 20,2022
PrInflod
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REVIEWS FRONT ZONING SUPERVISOR) PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW . REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.