HomeMy WebLinkAboutBuilding Permit ApplicationJ
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: a\OL �C) o L'i�
§I 17c `'t:.KI'm RECEIVED
ED
�i- API�P� 51 �2021
C o o
T Building Permit Application P IWU De artdent
LW
Planning and Development Services ; I
�oc
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: VA\e_NA\ �u'��a ���
Address:
Property Tax ID #:a�13�
.Site Plan Name:
Project Name:
irk `P,etCo, fL
New Llectrlcal Meter Jecond Llectncal Meter
Lot No.
Block No.
Additional work to be performed under this permit - check all that apply:
_Mechanical _ Gas Tank _ Gas,Piping _Shutters _ Windows/Doors _ Pond
XElectric _ Plumbing _ Sprinklers _ Generator XRoof 3 - Pitch
Total Sq. Ft of Construction: Lid Sq. Ft. of First Floor: 1, / 09
Cost of Construction: $7' r . 5 j Utilities: _ Sewer _ Septic Building Height:
A
L.4
$:,,.,
'�txra'•,.�.�r.�,'��.x�'i"m`�:�
__^�?d,e .. asE�,'H�.g .�r.�� _.�.��:�`:�e§fat„�.n"ii.��z�.i� R�::°�*--�.�.. �.���=
�. %��`r'-�.�.,� ?;,�...�e.,,k5 a-.u;re�z��v,3� �`. ��fs��., tx
Name �rMnSay�
Name:
Address: 313D
Company:
City::- RRrcL State: .
Address:
City: State:
Zip Code: 3q%� Fax:
Phone No. 7-19 --37 -- 3313 P
Zip Code: Fax:
Phone No
E-Maid:
Fill in fee simple Title Holder on next page ( if different
E-Mail
State or County License
from the Owner listed above)
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.
}yi jf„ ' `. 'LP 1C'�'�]J ': �e YY`..- "..�.' A� 9
-,uIC%r'vu',... tic. 3Ku"T04,F.fis'9RFp .... .� C. I...K�.y`
EM w.iP�.. C' p`.�f
"Y �"i. "If
DESIGNER/ENGINEER:
Name:
Not Applicable
MORTGAGE COMPANY: XNot
Name:
Applicable
Address:
Address:
City:
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
Not Applicable
BONDING COMPANY:
Name:
Not Applicable
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 lesaier or an attornev before commencing work or recording vour Notice of Commencement.
of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDS....,
COUNTY OF
Sworn to (or affirmed) and subscribed before me of
A Physical Presence or Online Notarization
this LS,-- day of Q, gA P 202Uby
Name of person making staten�ent.
Personally Known OR Produced Identification
Type of Identification
Probced
(Si naltiire of Notary Public- State of Floridb-)
Commission No. i r••'"""'•.,
q��jAM'RAHMINt4
PxPltlhli 2%2022
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this day of 2020 by
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
Produced
(Signature of Notary Public- State of Florida )
Commission No. (Seal)
'k• P�
Y11wr tl■Y
REVIEWS
50PERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.