HomeMy WebLinkAboutBuilding Permit Application ramgolam All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-15S3 Fax: (772) 462-1578
PERMIT APPLICATION FOR: R� GOL��
PROPOSED IMPROVEMENTLOCATION:
Address: U 161 Zi(" ,e� Pf�el-2
Property Tax ID# 9/5•62D/.3 •QQQ •2 Lot No.
Site Plan Name: � 6 L_-�C&� _ _ Block No.
Project Name: �i�/ Q
DETAILED DESCRIPTION OF WORK:
U/ �7 '
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: /390 deC/�_ Sq. Ft. of First Floor:
Cost of Construction: $ S Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name QQ to d � a Name:_ _ 140i — �w
Address: C� /�:D ,Die Company:
City: State: FL Address: ��5
Zip Code: 1-3y �L Fax: City: State:��
Phone No. Zip Code: �J�yy Fax:
E-Mail: /d/Y/ / !�'_L� Phone No J�/J
Fill in fee simple Title Holder on next page ( if different E-Mail
from the Owner listed above) St to or Con r ense
7A
If value of construction is 2500 or more,a RECORDED Notice of Commen n •
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: V 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.
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: Y failure to Record a Notice of Commencement may result in paying twice for
im ements torr
p perty. A Notice of Commencement must be recorded in the public records of St.
Lu iezarr
ande n the jobsite before the first inspection. If you intend to obtain financing, consult
wi h ! an ey before commencing work or recording our Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of C ntractor/Li ense Folder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
Swor to(or affirmed) and subscribed before me of Swor o(or affirmed)and subscribed before me of
VPh sical Presence or Online Notarization Ph s'cal Presence o Online Notarization
this day of /y 247/ by this day of / rim" 24z/ by ,4;.
Name of person making statement. Name of person making statement.
ra rsonally Known OR Produced Identification Personally Known ✓OR Produced Identificatio a ��
g r' pe of Identification n �p Type of Identification
oduced �L ��L /t J�o�l���Q ;JO 'QJ��Q Produced w 5 ro
1 to
1n r zi
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ignatur of Notary Public-State of Florida ) (Signat e of Notary Public-State of Florida
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` mmission No. GG 8���g
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(Seal) Commission No. (Seal)
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EVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
ATE
RECEIVED
DATE
COMPLETED
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