HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED J
Date: Permit Number:
;a ,
Building Permit Application
Planning and Development Services
Building and Code Regulation Division CoI11ITlerCial Residential iz
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Eli ig
MaLemu. - .p .s.�: �as•.' - - _ - -
Address: `ek _76P p"-6b-� ,Cif AIMO6 l� t/.7 "=
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Property Tax ID #: 4 Lot No.
Site Plan Name: Block No.
Project Name: ASS
a 3� r
is Cl C� C I i[ Iw l� ��d ^ f ot� 01��rT-
New Electrical Meter Second Electrical Meter (Affidavit required)
01 " 11_
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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: $ -)Qcp• z 0 Utilities: _ Sewer _ Septic Building Height:
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NameC�.<%A`CeS i; Name: 1�v4���� �r'i�ir�%fad
;� , ,,,t ,:,. • ; ,. .,• •, . ,,;;.;:;.�.:. ,� Com an ''an % r
Address: P Y� r3�T
City: L�F31�/l� ��_ State:L Address: 6 6,6 S ✓1�Y'oLu�C�✓'C�9
State: i>1-
Zip Code: VT26 Fax: '-- City: S rz-o-�--v-
Phone No. `7%oZ-o28�- 6'9 7a Zip Code: ��!�r9qy Fax: �-
E-Mail: 102719 GLC% e�UvllA� o '� 6'� Phone No^ 6?_37�d3.S'1
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Fill in fee simple Title Holder on next page ( if different E-Mail AJ (0 CC op�-
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.
"PNotApplhcable
DESIGNER/ENGINEER: e
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
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 oY-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 our Notice of Commencement.
Signatur wner/ Lessee/Co r as Agent for Owner, -
STATE OF FLORIDA -
COUNTY OF c
0
Sworn to (or affirmed) and subscribed before me of Physical Presence or Online Notarization
this Ii day of 20-W by
Name of person making stateribt.
Personally Known - OR Produced Identification
Type of entification Produced
(Sig e o Notary Public- State o lorida) •;.i!"C4iLASHAHNAINGRAM•RAHMING
*; ;* MY COMMISSION # GG 2T5060
Commission No. (Seal) m o`: EXPIRES.Dewmbet20,2022
Fl;�P'•• go dllwNotaryPubUCUndervaRM
REVIEWS
FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR
REVIEW
PLANS
REVIEW
VEGETATION
REVIEW
SEATURTLE
REVIEW.
MANGROVE
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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