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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: 30 _ Permit Numbers ;MR- b 7 3 b Cil • 14AR 3 0 BulWing Permit Application Planning and Development Services BuAding and Code Regulation Division 2300 Virginia Avenue,Fort Pierre Ft 34M Phone:(772)462-2553 Fax:(772)462-7.578 Commercial Residential PERMIT TYPE: . PRdFOSF.D.�IMPROVEMENT�L'OCATION; :=..'._-;,._.:::.- - - _ - - ..`.> •�-.` •,. Address: 113 N Las ©!as 7e Tkinsea GACA FL �� q PropertyTax lD#: �5// JrOD—Ob 30 —drr7O— S Lot No. Site Plan Name: Block No. Project Name: DETAILEb,DESCRIPTfON OF-WORK:. r. CONSTRUCTION iNFOBMAT10N: f =`x . s1 Additional work to be performed underthis,permit-check.all that apply: _Mechanical _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:$ O Utilities: "Sewer Septic Building Height: CONTRAC[OR== 4 Name_.. • &-n Name; Address: 960 A16 SkKe-T ;QWRrQe Company: City: 2SPnf&RCL. State:FC- Address: zip Code: V9!fZ Fax: City: State: Phone No. 15-6/-'kP# W Zip Code: Fax: E-Mail• c?/MEL&I A4a1,00-CCM Phone No Fill in fee slrhple title Holder on ni ext page(if different E-Mail from the Owner listed above) State or County Ucense If value of construction Is$2500 or more,a RECORDED Notice of Commencement is required. If value of HVAC is$7,500 or more,a RECORDED Notice of Commencement is required. r Tr OWN 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 JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." *nature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OF ��s�A C � COUNTY OF The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me this_S of (� .20 Eby this_day of ,20_ by WIAICC, Name of person making statement. �— Name of person making statement. Personally Known.-0'R Produced IdentificationFt -Personally Known OR Produced Identification Type of IdentificationType of Identification Produced F`I Produced �'A �+ ELLEN VA GHN �a `st..-':e�f deride W uA (Signature of Notary Publ -State of Florid o` Commission # Gqg @.dam f Notary Public-State of Florida) My Commissio Expires Co rg dVo. ELLEN VAUGHN (S October 22 missi No. (Seal) rr° State o Florida-Notary Publi �a Commission'# GG 270079 i,u��� i n xpires or 2 SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER R V REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev. i I I