HomeMy WebLinkAboutBUILDING PERMIT APPLICATION ALL APPLWAE E 'M MUST BE OOMM.ETED FOR APPLICATION TO BE ACCEPTED
Date- Jr' Permit Number
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierre FL 349a2
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox,click arrow at the end of line
Pfa {?SE1 `1PtC3VEMEtFiuom, N_-
Address: OLA LW 5 0[Aspo , l I e(S A& �5l
Legal Description:T►ls L.(a k Gs r�Lt.Y1-tr1A &(b
Property Tax to#:1 30 i' r 00 l 00 0 l Lot No.
Site Plan Name: Block No.
Project Name: 1homas M Q✓4- l(e-Nf-+
Setbacks Front Back: Right Side: Left Side:
OETA 1� ES PTISJN M WORK;
I. 4 Wt. *SkAm neat 4-ttm ,, 9FU i U'e. C Ck4
U it W i�h 10 KW beak.
wo to is perm —chedc aWn app
&VAC Gas Tank QGas Piping _Shutters Q Windows/Doors
Electric O Plumbing �-,..�t Sprinklers [J Generator i=t Roof Roof pibdh
Total Sq.Ft of Construction: r, Ft.of First Floor:
Cost of Construction:$ ubuuties Sewer D Septic BauhMing Height:
ov�rr / co R:
Name 8 Name: (P.+
Address: (t 1 c-�ghll $l)bisPO _ Company. f
State: ' Address-
City: _ . .
Zip Code: 3 S [ Fax: City:
Phone No. Zip Code: Fax:77,'L-4(Q -3737
E-Mail: Phone NCo
till in flee simple Title Holder on next page(if different E-Mail: I
from the Owner listed above) State or Cou License. U '1&,:3I X(P
tf value of rti n is$25W or more,a RECORDED Notice of i is required.
SUPPLEMENTAL CONSTRUC17ION LIEN LAW INFORMATION=
DESIGHERIMINEER: _Not Applicable MORTGAGE COMPANY. _Not Applicabie
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: Phase:
ER/CONTRAt rOR IDVtT:Application is here madam Obtain a perm€ito do the work and installation as mclicated.
€certify that no work or insta€€ation has commenced prior to the issuance of a permit.
St Lucie County makes no representation that is granting a persait NrJI asthordae the permit hol�to build the subject structure
which is in contact with any appCrcable Rome Owners Association rules,bylaws or and covenants that may restrict or prohibit such
structure.Please consult math your Home Owners Association aced review your deed for any restrictions which ma apply
in consideration of the granting of this requested perctait,I do hereby agree that t will,in all respects,perform the work
in accordance with the apprmied plans,the Florida&si€ding Codes and St Lucte County Amendments-
The following budding 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,-esidential use
WARNING TO O •Yaw t31hire to Record a Notice of Carrium en cenle nt array 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
cammencin work or recordur Notice of Commencement.
Signature of ownert Lessee/Contractor t r Owner Signature of ContractodUcense Wrder
STATE COUNT3FEtQRIDtO �� 1 f� COUNTY FLORIDAF
COUNTY OF � L
The forgoing instrument was acknowledged before me The forgoing instau ent was acknowledged before me
this�day of�i Q J 3i3A by t`a3s f SS+_day of_ 20�1 6y
Name of person npatting statemebt Name of persorymaking state nt
Personally Known V OR Produced€deer fication Personalty Known V oR Produced identification
Type of Identification Type of Traduced Identification
Producced�
(signature of Stat=hN
CONWELL (Signaler o 1' rcClyjfQtiNlf.Ftoridaj
:+ s Notary Public St, ,
er os Ntate of Florida Commission# i,
Commission N ta3ja 017839 Cron E _ (Seal)
�'S•+r �`` Ys Auk 21,2020 %',�e�',.dr` Yomm.,.xpoes ,
Bonded through Nati;ional..War Assn. '
REVIEWS FRONT ZONING SUpERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REV€EW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2117