HomeMy WebLinkAbout5157 AMINA.pdfAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date; zo-Permit Number:
Q....
c. 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 IMPROVEMENT LOCATION:
Address: --On 0J r
Property Tax ID #: f T (�, — b — Lot No.
Site Plan Name:'(' z P— & Block No.
Project Name:
DETAILED DESCRIPTION OF WORK.
I4
7 )
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:
Additionaf 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 5q. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ ��b T Utilities: Sewer _ Septic Building Height:
OW N ERAESSEE:
CONTRACTOR:
Name le Y
' AAddress:
Namej1��
t
Comp0<CityState:
"
Addre1
CityN W State:
Zip Code: � Fax:
Phon%Nc. ' E-
Zip Code: Fax:
Phone No
Mail: j" r
Fill in fee simple Title Holder on next
p p ge (if different
E-Mail �1 i'
State or County License
from the Owner listed above)
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.
)C-
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESiGNE E INEER: _ Not Applicable MORTGAn
E' MPANY: Not Applicable
Name: Name: _ `—
Address: _ Address:
City: State: City: State:
Zip: Phone _ Zip: Phone:
FEE SIMP E rffLE HOLDER: ^ Not Applicable
Name:
Address:
City:
Zip: Phone:
BONDIP
Name;
Address:
City:
Zip:
Y: _Not Applicable
Phone:
OWNER/ CONTRACTOR AFFIDV'IT: Application is hereby made to obtain a permit to do the work and installation as indicated.
certify that no work or Ynstailation 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 Count and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
with lend a an attorne before commencing work or recordin2 vour Notice of Commencement
Si t re of Con ctor - ' r -Owner Builder as applicable
S ATE OF FLORIDA
OUNTY OF�Ld
Swor to (or affir ed) and subscribed before me of Physical Presence or Online Notarization
this % day of _ 2022-by
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification Produced
(Signature of Notary Public -State of Florida)
Commission Na,� �� RM
in'r'�`LSCN
J i rr�5ea I jblic • Scare of F{orida
sicn # hh 1�vp�rcpires
:ul 19, 2025%V4r.ii %�g&-�Ayfn,
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
-
COMPLETED