HomeMy WebLinkAboutBuilding Permit ApplicationPern-flt Number -
Date:
Building `11cati n
23W ViMmin Avenue, Fort Pferce FL I Residential ,�--
Phone: (772)462-1553 Fa c. (7721462-1578 Commercial —.
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of Une
PROPOSED )IMPROVEMENT LOCATION:
Tax ire #: �'
A Lot No.�.�
property
PArw-k No,
Site Plan ane`
Project 1"1TW-
Back- Rpt �= Lem Sick-
&ff—,MI DESaUpmoN OF WORT.
CONSnUjCTION IFORrMATION_ _ - - -
,101-1, :1 :11:11 YYhili4L tGasTank
iiUf;ilii llf1U'e4 i.1iFS 6Ffiii.�4lie`CFcX11 apply.
HVAC as Piping � Shutters � win�lows/iiaors
tilectric U Plumbing 13Sprinklers Generator Roof Pod pitch
Total 5q. Ft of GonStrutt 5q. Ft. of First Floor:
r-
cost ot n: � % �f%Cr, cam! Lftgfnes- � j�` � `
I WNERA S EE: CONTRACTOR:
A Wess:
::it-:
Zip �:: q Fes.
-------------
E-Mak
Fig "enfee shnplerate Holder on roma page(ifWkmd
tum the Owner 1 -jaw aba j
comwv,
Citrl State--1�7)
Zip Code. Faic
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purecarWuntyIW: � 3�
It value of construction is $25W or more, a RECORDED Notice of Commencement is requhv&
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
Name:
MORTGAGE COMPANY: Not Applicable
Name: T
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
BONDING COMPANY: Not Applicable
Name:
Address:
Address:
City:
Zip: Phone:
City:
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, 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 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 Commencement.
Signature of Owner/ 14 ssee/Contractor as Agent for Owner
Signature of Cont ctor/License Holder
STATECOUN O OF FLORIDA if ) y-)COUNTSTATE
OY OF FLORIDA r .
11
The forgoing instrument was acknowledged before me
this 2-7 4,klay of 'I -IL 64 20A by
The forgoing instrument was acknowledged before me
this;Zrday of L_ 26LL by
'� ✓1 1C ��- Q.1'r (�C
r Q.n�%C 1-i 4 r'r d ,
Name of person making statement
Personally Known OR Produced Identification x
Type of Identification
Produced FL, 1) L
_
Name of person making statement
Personally Known OR Produced Identification
Type of Identifica '
Produced L
(Signature of Notary Pu�O-ate of f=lorid .
S of Florida
Commission No. 9�oFr`4 ` YCommi s44/01i1424
Commission No. GG 142439
(Signature of Notarg,,%Iic- State of LFlor lSB tOdrlt
t
Commission No.** oP. scion xpi 44/41/2426
of f0 Commission No. GG 142439
REVIEWS
FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR
REVIEW
PLANS
REVIEW
VEGETATION
REVIEW
SEA TURTLE
REVIEW
MANGROVE
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17