HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
CATr7( C! (• �L��
Date: —�10.1'1gar o2 Do� p�- Permit Number:
-'9U o �UiColp:
r
Q-:i..•-Dc--`---` BI1.69ld91t1g 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
PERMIT APPLICATION FOR:
Address: ,2�0,§ /Vl
���• g�� DDSs . �o Lot No.
Property Tax ID #:
Site Plan Name: Block No.
Project Name:
,�e�l"`'���'. }'•4 4iMg
P -.MEN-
ica^,�-}. "i� ' �+m
,INiT� µY�� �n .
k I !a P V11` ,
New Electrical Meter it
i
E '.. "'. ,E•-i-4�:, '� 'u '.�.y.�.;_t �y�ks"ii' � 7i,- ^.F'A��.y,'-�L•�' �+��'� � � �-l�sl -�` '.��},�S ,��' y� ; "/'F �'�}�T�i�4�� ',l
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: $ Utilities: —Sewer. _Septic Building Height:
..
I Name: �) , o%ierG.visYODf �JI LL V
Name ��rD `i ' 14..,' `� _ ''
Address: D �'� '� I Company:
City: Address:
Zip Code: _'�_q 91// (� Fax: City: State:
Phone No. ( iii "37/-1 �1 Zip Code: Fax:
E-Mail: lP_rOhi,�0 Phone No 77T/� --'%b?/9
Fill in fee simple Title Holde on next page ( if different E-Mail
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.
4
MORTGAGE COMPANY: _ Not Applicable
DESIGNER/ENGINEER:
_ 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
which is in conflict with any applicable
structure. Please consult with your
that is granting a permit will authorize the permit holder to build the subject structure
Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
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.
Lucie County and posted
with levder or an attorney
A Notice of Commencement must be recorded in the public records of St.
on the jobsite before the first inspection. If you intend to obtain financing, consult
before commencing work or recording our Notice of Commencement.
Y-_ W✓
i nrature of Owner/ Lessee/Co
STATE OF FLORIDA
actor as Agent for Owner
,
COUNTY OF C�')A. }�.
Sworn to (or affirmed) and subscribed
this day of
A
before me of Physical Presence or Online Notarization
20_ by
i
i
Name of person making statement.
Personally Known OR Produced
Type of Iden " ication Produced
Identification
(Signature N ary Public- State
Commission No.
of Flo a)
(Seal) s"y"4,,. LASHAHNAINGRAM-RAHMING
MY COMMISSION # GG 275060
o o`= EXPIRES: Desembet 20, 2022
E ov Bonded Thru Notary PubUc Uw6vrMrs
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 5 2 21