HomeMy WebLinkAboutBUILDING PERMIT APPLICATION z
ALL APPLI LE 1 F MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED r 1
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Building Permit Application
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VAding and.Cc&Regulation Division
2300Vinginio.Aoenue,.Fort Piefce FL 31982:
Phone:(772)462-1553 Fax(772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROP_ T _
Legal Description•
PropertyTaxlD#: cad Lot No. \
Sit .flan-Name: 'lock No.
Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION:;OF WORK.
s
CONSTRUCTION INFORL�IIATION
Add
rtio
. ' HVAC Gas Tank
tjGas�ip-lng Shutters lhlindows,Daors
_Electric Q Plumbing OSprinklers _Generator Roof
Total Sq.Ft of Construction: S .Ft.of First Floor:
Q�
Cost of Construction:$, IS Q U Utilities: _Sewer Septic uildigg t r
Name (.A l�� f �(JG G°' Cdr Name: C¢
Address: Company: KffLc, at/k-,O-eft
City:. VLA-1. Q,_M4 t State: Address: CO3 M h--
Zip Codp--
Pj vp6. /— Zip-Coder L676 Y-Far.
E61: Phone No. C4. 5,3 tel,
Fill in fee simple Ti a Holder on next page(if different E-Mail: ce tr ecGt 0�
from the Owner listed above) State or Coun cense:
If - pin .
I
D ENGINEER: ..Not ApplicableMORTGAGE COMPANY: —Not Applicable
Name.' Name:.,._ _
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE
144tke: _ Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
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 is in conflict with any applicable Home Owners Association rules,bylaws or and covenants that may restrict or prohibit such .
structure.Please consult wtthyour Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit,I do her ftogree 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,screewrooms�and accessory uses to another non-residential use
WARNING TO OWNER:Your failure to Record a Notice of Commencement may result in your-paying twice foe
improvements to your prgperty.A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection.if you intend to obtain financing,consult with lender or an attorney before
commenwig work or recording our Notice of Commencement.
Signature of Owner/Agent/Lessee Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA •
COUNTY OF e UG COUNTY OF i�
• e
The f oing lnstr#mer4 was acknowledged before me The mg in e acknowledged before me.
day of IIE19L
-20 1 thiday of20i�by
C Coe�_
ne f person acknowledging) (Nam of person acknowledging- C'�, (v\ n
)
(Signature of No Public-State of Florida) Sijhpp9e\qt dbt&ry u lic-Sta XeFlorida)
ersonally Known r Id n ' tion Personalliy no OR Produced Identification
ype o en d Type o en on F
Notary Public-State ofFlorida =_%4 Notary Public-State of g/�prid
• Commisifiealt)FF 234730 Commis _ N ` ` #FF 234P99a'
Commission No. •-
°FF��;?,• My Comm.Expires May 27,2019 N;.FOFF`OP°r' My Comm.Expires May 27,2019
Bonded through Na ",IF... BOOM thlough National b
Revised 07/15/2014
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