HomeMy WebLinkAboutBatiwalla 1All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: � Z:2- Zc�`z Permit Number:
91`1Cll L.' QL9
P, MWILPT07" , Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
Address: 9 5-M 8 oar V),- _ moons-e Y) bmc. e YG
Property Tax ID #: y J o? - 6oz - o) 5-6 `' 0W - Cf
Site Plan Name: �-S�C1viC�E� Ct7V1C��l'►tl✓i�u O'n 1 1702-
Project Name:
DETAILED DESCRIPTION \\OF WORK:
e _in `ra Cam_
New Electrical Meter
Second Electrical Meter
CONSTRUCTION INFORMATION:
(Affidavit required)
5-7
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
Electric Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
r�
Cost of Construction: $ Utilities: _ Sewer _ Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
NameCc �i
Name:
Address: 12610 -S Ar. n t- 1 0-a
Company: 14,Acl
Address: 231�_%X, e�Hi�-,
City: State: XL
Zip Code: `��� Fax:
Phone No. E-
City: 3�_M,61 &f,\-LVN
Zip Code: _3 CIS 7 Fax:
Phone No Z
State: __F_t
2,- 2 ZSJ-�J
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail
State or County License C- tA
7/
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.
9M6Lt t , C-Ci 1p1
I SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: I
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Name: _
Address:
City:
Zip:
one:
State:
BONDING COMPANY: _Not Applicable
Name: _
Address:
City:
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 conflicts with any applicable Homeowners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Homeowners 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
wit or aro attorney before commencing work or recording our Notice of Commencement.
Signat Owner/ Lessee Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF
Swor to Lgr affirm ) and su scr_ibed before me of Physical Presence or Online Notarization
thisy of 2Q,? by
TF-5-5 EEL I I e + ---
Name of person making statement.
Personally Known OR Produced Id ntification L/
Type of Identification Produced Lit-- V C-
(Signature of N ublic- State of Florida)
&A ) o'gAy P4,, JESSE DOSS
Commission No. ?
a -
* * Commission # GG 263069
m1 `oe Expires September 27, 2022
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Rev 5/20/21