HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED //��
Date: Permit Number( 10 U -Q
S�TLC LU11.1CC.L
9 Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial
2300 Virginia Avenue, Fort Pierce FL 34982 M;
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Address: SO
C
Residential
ni
Property Tax ID #: 1301 •� ��` 01 ( ) .0002 Lot No.
Site Plan Name: Block No.
Project Name:
New Electrical Meter
Second Electrical Meter
(Affidavit required)
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: $ y'. 3Q�A l Utilities: —Sewer —Septic
Building Height:
f31lUNER/LESSEE
R g iNk �
Cfi -Y
C C?NTR
ALTO
R �
i, a yry .+:-` •..�.,.✓�s --LA'S ru- w�'fn.
, i .
a
9 < F $, �
Name `j,L (
; :Name:
min Y
+;.;
Address: �h l� 3 GS-�c� r'"~' '�',' ;; ;,�+
' Corripany:�-�-[�
6� 5'1
(-
Y'cJG'�'
i 61� �•
y: •� �State':�L= �
Citc,r�r- �1 �e�-= _
i
'� Address: 1AP73/ Alf aAR
let'✓. CX---
City: Mi 6rrdl
State: Fz—
Zip Code: ?i31711 Fax:
Phone No. %E��. Li EZ T7&
Zip Code: .S317q
Phone No % 66. 5 9 7.
Fax:
q—lol
E-Mail:
r
Fill in fee simple Title Holder on next page ( if different
E-Mail ras hl&eL he hr
i
State or County License C&C
/_Spq4,:3
from the Owner listed above)
If value of construction is 2500 or more, a RECORDED Notice of Commencement is regwrea.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
'? k$Y ��& 3� �F �� - �d� ! 'iL ,ia
�"
SUPRENlNTAL CQNSTRUCTl41l.�ENf !AW lT�IIC}l�l��MA1'JQlU
➢ gi � 1 9 :h ekd'.W-,)� Yqd t4 h ..y. 4 � b1 .t� i �
�'' S 'i'l P�'�3� •'�Ss' "4..3 �i �� � 3� � "�., 5 $ £Y� � £ K�. ti� '�
£y,5 d$
MNot
M�
DESIGNER/ENGINEER:
_ 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.
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 recording your Notice of Commencement.
Signature of wner/ Lessee/Contractor as Agent for Owner
STATE OF FLORID
COUNTY OF k 0 ,
\
Sworn to (or affirmed) and subscribed before me of V Physical Presence or Online Notarization
this day of 20_ by
Name of pers n,rnaking statement.
Personally Known_ OR Produced Identification
Ty of Identification Produced
(Si at re of Notary Public- St a of Florida) mom.
LASHAHNAINWMMA RAHMING
�
Commission No. (Seal) :.; �: MY COMMISSION#GG27506D
I : December 20, 2022
7 EXPIRES;
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW.
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev