HomeMy WebLinkAboutBuilding Permit Application - GhorayebAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date
Permit Number:
NJ', c LucUI�
p c ° Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial � f ` 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: 575D S Our-, 0-6*e- [1 ,- g3�- IzA." (
Property Tax ID #: S53 5-tP9 I OD q j W,' LP Lot No.
Site Plan Name: Block No.
Project Name: 4b n(
DETAILED DESCRIPTION OF WORK:
.L. Iti 14 "•�1— ; "1
Le+.E L., (. //di�+ �b.i,✓ ,^ V P K"w i/'4 %j/li`' �-. �. l� �tA"}'`1 Oi ,p�v+►C•��
New Electrical (Meter Second Electrical Meter (Affidavit required)"/ C4(nr
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 _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: 1,56U Sq. Ft. of First Floor:
Cost of Constructio-n: $ rd �� Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:
Name ilnrevo i v V
Address: T-M D 5 61 &.4
City: 'Jet ItA Barin State: —EL
Zip Code: 3N1 Fax:
Phone No. 'ids �21 NI —A I E
Mail: P1(��IP�2AVE130d-'Ifll-/.DL
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
CONTRACTOR:
Name: J, e& Sa- ti<lur k
Company: 160401% 94m.b
Address: S'II S %m,�;�•+^tom �1T'�
City: �k�'� State: �L
Zip Code: GhN Fax:
Phone No fro l 4SW °iS
E-Mail ',A4D-IMK(- 1��{�i li�i'+G:l Li►1
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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: _Not Applicable
Name:
Address:
City:
Zip: Phone:
Address:
City:
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 befowt—ommencing work or recording your Notice of Commencement.
Signatu of Contractor or - wrier Builder as applicable
STATE OF FLORI A _
COUNTY OF Lv
Sworn to (or affirmed) and subscribed before me of `'� Physical Presence or Online Notarization
this —1 day of v 2OQ� by
Name of person making statement.
"/-
Personally Known OR Produced Identification
Type of ntification Produced
(Signature of Notary Public- State of Florida)
Commission No. S Lo'Sto (Seat) 400 Notary Public State of Florida
Rebecca G Deepan
WIN
MYHH 1736561on
a M1`� Exp, 91912025
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