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HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE IN MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 1 Hate: �� �i�S I Permit Number: j V y � Building Permit Application ation PlunWiT Fnd DevelopmentServitss Building an Csde P2egulotion DM'Sion 2300 Vergiala Avenue,Fort Pierre FE 34.9 Phone:02)asp-ss53 Fax:Wiz)�z-zs�� f ommercial � Resident i PERMIT'APPLICATION FOR: To Select from dropbox,click arrow at the end of Eine :PROPOSED IMPROVEMENT LOCATION: Address: l} � . ll . T Oa Legal Description:_ 'J rf — j�- o 00 J ,0�& I Property Tax ID#i: ( Lot No. Siete Plan Name: ( Block No. Project Name: t Setbacks Front Back: Right Side: Left Side: DETAILED DESCRIPTION OF WORK: f 5 6_03 I CONSTRUCTION INFORMATION: Additionalworictopenertormed( .under this permit-check all apply: 11HVAC Gas Tank E]Gas Piping _Shutters F]Windows/Doors [Ll Electric Plumbing []Sprinklers 0 Generator O Roof Fled pdch 'Total Sq.Ft of Construction: I So.Ft.of First Floor: i Cost of Construction:$�� �. �� Utilities: Sewer[:]Septic Building Height: l OWNER/LESSEE: 1� o ; Svc CONTRACTOR: Name ,�9 -r Name: Address: Company - f� �cJcupkcs City: State: Address: d Ala Trp Code: Fax:1 City: hi�` State: Phone No. Zip Code: 6�3 ' E-Mail: ( Phone No. � I Fill in fee simple Title Molder on next gage if different E-Mail:edn arac_ QL from the Owner Cisted alcove) I State or County License: 00 If value of construction is$2=or more,a RECORDED Notice of Commencement Is required. I i SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION`.' DESIGNER/ENGINEER: I _Not Applicable MORTGAGE COMPANY: _Not Applicable Name: Name: Address: I Address: City: I State: City: State: Zip: Phone I Zip: Phone: I FEE SIMPLE TITLE HOLDER: i _Not Applicable BONDING COMPANY: Not Applicable Name: Name: Address: i 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. 1 certify that no work or installation,has commenced prior to the issuance of a permit. 4 St_Luciie Court�mattes 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. t in consideration of the granting of this requested permit,l do hereby agree that I will,in ail 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 commen ' rk our Notice of Commencement. Sign Owner/Lessee/b6ntpctor as Agent for Owner Sign tur ntractor/License Holder STATE OF FLORID + ( STATE OF FLORIDA COUNTY OF � �0't,C7�- COUNTY OF The sing instraarrtent as ackn6wfedg.d efore me . The oing instru ant vas acknowledge afore me this day of C1 20 by thi�day of 20Jby - Name of person making statement o / ame of person m king statement Personally Known OR Produced Identifi ion V Personally Known OR Produced Identification V Type of lit tionType of Ida cats n �p Produced VS �-i Kul Produced� �� 51 r (S' nature of Nkary Public-State of Florida) (Signature of Notary blic-State of Florida) � IIAI(ELIZABETH CANALFS Commission ti�©. .•••",Y'�,'• GEO��CIZAB�TM CANALES Commission Ido. .••'; ,.: GE "`��jj�b *�, Nary lk-State of Florida .M1 Notary Public-State of Florida •, �fi �. a • 1�914Q(U• Cammfssion p GG 124400 Commission q GG i 24400 ;;�,� <<LroY` My Comm.Expires Nov 11,2021 r g alionalNotaryMsn. Bandedthroug NaliooalNotaryAssn. a r REVIEWS FR PLANS VEGETATION SEATO � P COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE j COMPLETED Rev.8J2J17 i I ' i