HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE.ACCEPTED
Date: 02'04 -2Z Permit Number: \!!J'0���
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RECEIVED
:, :.,0 :•.:r... Bufldgng Permit Application
FEB 0 4 2022
Planning and Development Services J=unStty
Building and Code Regulation Division Commercial Resid-ential —
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-15S3 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATI0N FOR: .,..,9 �^
4 ME
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Address:: 3Lj Ll zI F� KJ I' A 0 -y .e= 2D 2-
Property Tax ID #: -94 W O•3u1 -OOOa '0003 Lot No.
Site Plan Name: Block No.
Project Name:
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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:
0
Cost of Construction: $ ��� Utilities: -Sewer _Septic Building Height:
9
_
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rcNamer`1111i�1 1L1 Ol C,.li.` �rv';rj�=� r'�.��ia 7t 3 `, v r c ~.Name:
Address: s uCu S. �cytD 1`'A �•�, �:,cZ!,� 1� sl ?� ,ompany:
City: i'0(1i�1'('�Qe�'rru�a.r,,r,tattnS.tate' _ �Pddress: 1
Zip Code: 3�-1q%1- Fax: - City: State:
Phone No. 305--Z\(3—(e2-2 E- Zip Code: Fax:
Mail: l,ti Go \� 1�a��l�S Q 60" COM Phone No
i
Fill in fee simple Title holder 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.
- -
10
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W__
d 75 , - -
MORTGAGE COMPANY: _ Not Applicable
DESIGNER/ENGINEER: - Not Applicable
Name:
Name:
Address: ' ` -`'
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLUTITLE 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 1 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
h I d tt before commencing work or recording your Notice of Commencement.
en w1t er or an a orney
I
Signature of Contractor - or - Owner Builder as applicable
STATE OF FLORIDA
COUNTY OF
Sw.or to (or affi ed and subscribed before me of
'N Physical Presence or Online Notarization
this 'r day of 20_ by
Name of person aking statement.
Personally Known OR Produced Identification
Type of I tification Produced
rs�,— �4�-
(Signa f otary Public- State of Flo ' a)
-
Commission No. (Seal)
;;s' ., LASHAHNAINGRAM•RAHMING
;i$• ', MYCOMMISSION #GG275060
EXPIRES: December 20, 2022
•'? :SOP R� �Q` 80nded TMu Nauq Public UndemlWs
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