HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED'
Date: Permit Number: /;L'
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° Building Permit Application
Planning and Development Services
Building and Code Regulotion-Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 CBDG Funding
PERMIT APPLICATION FOR:
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Address: QQ,
Property Tax ID'#:
3gOL _ Sod 0L4 l� D � � Lot No.
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Site Plan Name: C' .o rolh"/C,1S' Block No.
Project Name:
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New.Electrical Meter Second Electrical Meter (Affi avit required)
- eE.;,s sa' ,a :�a6.�'�"' ..,.?^ t.,.:��� �"'�.. �4.xN-� 455 u... .,�i��•4�m'� .,.ti. � _ ,.+e.• `:�-•.-a.,.,.sx�.ls .».. _ .�.
Additional work to'be performed under this permit—check all that apply: _
—Mechanical Gas Tank —.Gas Piping Shutters_ _.W.indows/Doors . _Pond-
Electric Plumbing —Sprinklers Generator _Roof Pitch
Total Sq. Ft ofCdr1struction ': Sq. Ft. of First Floor:
X —Sewer,, Septic Building.Height:
Cost of Constructi Utilities:
as:+ aaF-.• ,Pr'.'. „ccsr'aFrr, ..s• - su '*r,3'�`' _
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Name t��\�� C7 0 �� a' Name:
Address: I%tO w.P^1d�c.�—ray tZ� Company:
City: >'e,-ir- *c Q State: L Address:
Zip Code: `L $ Fax: City: State:
Phone No. ?7 2 -�k(v S1 ' « `T E- Zip Code: Fax:
Mail: G F L o A A U 9 CQ. %cmr-� W Phone No
Fill in fee simple Title Holder on next page (if different E-Mail
-above State or Count License
from the Owner listed ) Y
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 permitholde'r 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 @.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 fail ureAoAlecord 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 p�ited on the�jobsite before the first inspection,: If you.intend to obtain financing, consult
with lender o o ney before commencing work or recordin our Notice of Commencement.
--,fig ature of Cc, actor-or-owner Builder as applicable
STATE OF FLORIDA �
COUNTY OF •EA-s ��
Sworn to(or of it e and subscribed before me of Physical Presence or Online Notarization
this day o by
Name of person m king statement.
Pe so ally Known OR Produced Identification ,
LASHAHNAINGRAM-RAHMING
T te I Identification Produced •"�:
`; MY COMMISSION#GG 275060
EXPIRES:Deeember20,2022
k Nnvf,��V�JxcF Bor?M Thru Nof q Pubric Undw*TI ais
ign atu rA of Notary Public-State of F ) '
Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION . SEATURTLE > MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 2 1