HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1- —� 1 Z Permit Number: Osbl �13
0 ,
P ° - ' - ° k` p,•-• 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
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: —fe-,2 /1- S h re W%adf Vr, tv/l Ffe',_ee ri_ `fY±l
PropertyTax ID#: J�'IT'- 7al --Q/76 —Ob0 '" `7"' Lot No.
Site Plan Name:
Project Name:
Block No.
DETAILED DESCRIPTION OF WORK: ,
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit —check all that apply:
_Mechanical _ Gas Tank —Gas Piping _ Shutters _ Windows/Doors _ Pond
Electric _ Plumbing T Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction
Cost of Construction: $ _� i ilQ%
Sq. Ft. of First Floor:
Utilities: —Sewer _ Septic Building Height:
OWNER/LESSEE:
1,
CONTRACTOR:
Name[Vk-�A Aeazil,
Name:
Addres : 2 s11 /
Company: O �
City: State: _
Address:
Zip Code: Fax:
City: _ /e/�'C� State: AL
Phone No. E-
Zip Code: Fax:
Mail:
Phone NoZ—
Fill in fee simple Title Holder on next page (if different'
E-Mail �S'cnt �i 6es� _� .��oq ��,.. �,•�
from the Owner listed above)
State or County License
�ofl 1e is 290D a marq a mow u mumaFtomammamm P9 re mew
�K � I�� � $7,!500 ar � a R60DRD®Mo�ice of fis r�
SUPPLEMENTAL CONSTRUCTION LIEN, LAW INFORMATION:
DESIGNER/ENGINEER: _ Not 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 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
With Ipnrlpr nr an attnrnpv hpfnrp rnmmpnrinE work or recordine vour Notice of Commencement.
, 2Z
Signature of C racto or- Own ilder as applicable
STATE OF FLORIDA
COUNTY OF
Sworn to (or affir d) and subscribed before me of �'
this � day of 20o�by
C\ WA\_\X\LA" a 0 X\ WNLX)TA�
Physical Presence or Online Notarization
Name of person making stat0ment.
Personally Known OR Produced Identification
Type of I ntification Produced
(Signatqr f otaryPublic-State bY Florida)
_
• pl%. ' LASHAHNAINGRAM•RAHMIt, , I�,
�• " MY L^^r �¢
Commission No. (Seal)
:�r: ON# GG 27�.: �A
?t•*A@
EXPIRES: December20,2(... •• Bonded Tlw Notary Public Unden:,-:'
�JJ
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev iu/12/21