HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TOPE ACCEPTED
` Date: ' Permit Number: -
Building"Permit Appli cation-
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Planning and Development Services ..
euildirig and Code fiegulatron Division CO1'lY mePCial ReSldential
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a 2300 Virginia Avenue,Fort Pierce FL 34982-
Phone:(772)4624553 Fax:(772)462-1578 -CBDG Funding- --
PERMIT APPLICATION FOR:
Address — I L 'v
Property Tax IDM ' ��3� - l a1 0003- moo-� Lot'No. '
Site Plan Name: Block No.
Project Name:
1TETAILED DESCRIPTION OF WORK
og_ o S4.wULfa -n n - Ol rs 6' ►+�_ L4C.h'-r, o o Q_
New Electrical Meter Second Electrical Meter " (Affidavit required)'
CONSTRUCTION INFORMATION
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Additional work to be performed under this permit—check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters v Windows/Doors Pond
Electric _Plumbing _Sprinklers _Generator _Roof ' Pitch
`Total Sq.Ft of Construction: S Sq.Ft.of First Floor: "
Cost of Construction:$ C> . Utilities: Sewer Septic Building Height:
OUVNER/LESSEE y n CONTRACTOR f f
Name Name: (1FQ•I E�iiciF�
_
Address: Company:
City: �QiCf°M1'`'ti,r.;ti uv`r: 5ne' _ state: Address: 31)2c) Ll�ML QC�
Zip Code: �L(q��` Fax: - -City: State: �L +
Phone'Nd. '. E- Zip Code: I Fax: -
Mail 4l f I e 6YVL Phone No `779_-579'3.S(c
Fill in fee simp a Title Holder on next page(if different E-Mail h RQRa'5
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.
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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-lender or an attorney before corrimencih 'work or recording-our Notice'of Commencement.
Signature of Con clot-or-Owner Builder as applicable S<
STATE OF FLORIDA
'COUNTY OF
Sworn to(or affirmed)and subscribed before me of Physical Presence or Online Notarization
this_VJ),day of 20&DD by
Name of person making statement_
Personally Known OR Produce_d Identification
Typ of Identification Produc
na ure of Notary Public-State of londa)
- ' LASHAHNq INGRAM.RAHMI
NG
Commission No. (Seal) =*e ;.z tiB'COMMISSION#GG275t? °
EXPIRES:Deter ber 2e.20?'%�
. Bonded Thru Nola Fabric U
REVIEWS FRONT ZONING SUPERVISOR, PLANS VEGETATION_ SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE - -
RECEIVED
DATE
COMPLETED
Rev -