HomeMy WebLinkAboutBuilding Permit Application ALLAPPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BEACCEprW
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Date: Permit Number.
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Building Permit Application
Planning and Developmentswiriires
Building and Cade Regulation fthlon
ZVO Wginto Avenue,Fort Pierre FL 34982
Phone.(772)462-1553 Fax(772)462-ss7s -Commercial Residential
PERMIT APPLICATION FOR: TO Select front dropbox, dick arrow at the end of line
PROPOSED IMPROVEMENT LOCATION: :-
Address: 9- 07 7 t t&v Gera ( j 1 m JC1
Legal Description: '��ey t.v 1 i� S e�d
Property Tax ID#: t 5 5 OCOT- C300 " 6 Lot No.
Site Plan.Name: " Block No.
Project Name:
p Setbacks Front Back Right-Silde: Left Side:
I)ECAILED-DESCRIPTION OF WORK:
CONSTRUCTION-INFORMATION:
Additional Work toene rm un er permit- a apply:
HVAC OrG'OasTank [:]Gas Piping Shutters OWIndows/Doors
DElectric 1:1 Plumbing Sprinklers L_I Generator Roof
Total Ft of Construction:
�. � � " .Ft.of Fid Floor.
Cost of Construction- [�''�`�
•$ ��� Utilities: Sewer LilSeptic Building Height:
OWNERAESSEE: CONTRACTOR.-
Name v c Name: rs C
Address: er VC, fPT Company:
Gly: �, t tree �1 Address: Z if e<
Tip Code: ?2 19. Fa�_,,,�1,�? City: f f Z±p1-r--+E�i
Phone No. Tip Code: t f�f " -fax: Z•7 t' �{
E-Mail: Phone No,
Fill in fee simple Tide Holder an next page(if different E Mail• re reCfr Q
from the Owner listed above) State or Cou 'cense:
ff value of construction is$2W or more,a RECORDED Notice of Commencement is required.
DESIG"ER/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: p Address:
City City: ,
Zip: Phone: Zip: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit
St Lude 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 Assoctation rules,bylaws or and covenants that may restrict or prohibit such
structure.Please consult withyour Home Owners Association and review your deed for any restrictions which may apply.
Inconsideration 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 Lude County Amendments.
The following'building permit applications are exempt from undergoing a full concurrency review:room additions,
accessory structures,swimming pools,fences,walls,signs,screemroomsand accessory uses to another non-residential use
WARNING TO OWNER:Your failure t4 Record a Notice of Commencement may result in your flaying 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 finan-ting,consult with lender or an attorney before
commencingwork or recording our Notice of Commencement.
Signature of Owner/Agent/Lessee Signature of Contractoi/License Holder `
STATE OF FLORInA STATE OF FLORIDA
COUNTY OF 1Q COUNTYOF oa,
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of y ,-.2014 this of ,20_1A by
pPersonfalIV
erson acknowledging) (Name of person acknowledging)
of Notary Public tate of Florida) gn reof Notary Public-Sta ofFlorida)
Known OR Produced Identification Personally Known OR Produced Identification
entification Produced Type of Identification Produced
Commission No. _,--. (Seal)_ -uCommission No.
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Li'.�hi;IINA INSHAi+I :D��rCb011% LASHAHNA t
Notar'Public-*.Stara 01 Florid' _ _'�; o': NOtary Public-Stnt
Comm.Expires uec RI.Expires Dec 20,2p18
Revised 07/15/2014 _%, "a`: commission#FF 177249 �oa� COrtlrDlssfon 7�FF 177pgg
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