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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 'Date: Permit Number: i' Building Permit Applicati don Planning and Development Seruices > u r, Building and Code.Reg'ulation•b1Vision " ' 2300 Virginia Avenue,"Fort;Pieitce FL 34 $2, k;• Phone: (772)462-1553 .Fax (772)462-1578 tCorrmercial Residential PERMIT APPLICATION FOR: �� c� Address: 721 Legal Description • p, Property Tax ID#: �• ©� 01 Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: C3 c o CuAdd . I• itio work tone performed unclerthis permit–check all that appy: echanical Gas Tank Gas Piping _Shutters 'Windows/Doors Electric _Plumbing _Sprinklers _Generator _Roof. Pitch Total Sq. Ft of Construction: Sq. Ft.of First Floor: Cost of Construction:$ cu in Cf U Utilities: _Sewer, _Septic Building Height: Name iA A —Am r _ Address: a . Jzn\ Company: City: !( State: �+ Address: 111VIAQ l/1/I Zip Co e: Fax: City: State: j Phone No. Zip Cod Fax: E-Mail: Phone No 7 d Fill in fee simple Title Holder on next page(if different E-Mail from the Owner listed above) State or County License d26 If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. 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 is in conflict with any applicable Home Owners Association rules,bylaws or and covenants that may restrict or prohibit such structure.Please consult with your Home Owners Association and review your deed for any restrictions which may apply. In consideration of the granting of this requested permit,l 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 your paying twice for improvements to your property.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 commencing work or recording our Notice of Commencemen U Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder STATE OF FLORID0 STATE OF FLORIDA COUNTY OF COUNTY OF The forgoing instrument was acknowledged before me The fgrgoing instrument was acknowledged before me this day of 20%1 by thisL_1 day of SR, ,20a by . (Name of person acknowledging) (Name of person acknowledging) (Signature of NotaryPublic-St4te of Florida) (Signature of Notary Public-St a of Florida) Personally Known OR Produced Identification Personally Known OR Produced Identification Type of Identification Type of Identification Produced LASHAHNAINGRAM Produced ;•r�. Notary ublic-State of Florida Commission No. _' MYCI Dee 20,2Q18 Commission No. a"+,ra:, LA"ill INGRAM 8ondedthrosahNation I Notary 41 Assn. fir° ,ate- Notary Public-State of Florida _ . 16, +•E My Comm.Expires Dec 20.2018 Commissio # FF 1772 REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETA Oi "SEAQ"'' `MA�`tl',rV, COUNTER REVIEW REVIEW REVIEW REVIEW" 'REVIEW `` REVIEW DATE RECEIVED DATE COMPLETED Rev.