HomeMy WebLinkAboutBuilding permit applicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ,Permit Number:
Building Permit Application
Additional work to be performed under this permit -check all that apply:
Mechanical Gas Tank Gas piping Shutters Windows/Doors
Electric Plumbing _ Sprinklers Generator Roof
Cost of Construction: S Utilities: _Sewer _Septic BuildingHeight:
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Name Sha+/ D\r\ LaJ+rv` CL/\Name:John grD~n inQ`
Address:3al5' PfJDo6}' Tre,e S}company:Cig rfu € gliroThccL`
City: C`Y{LmLI State:FL Address: ls3`~ tr`u fit+Oul C.J
Zipcode: 3GfiJLI Fax:city: Stw, state:FL
Phone No. |\ho ~ LHLt -3633 Zi code: '2ulq3ti Fax.
E-Mail: Si+3r) * air. r\ul Pqwl!uJ) icL)^`PhoneNo ill.ln6L -n3!-\,
Fill in fee simpl: Title Holder on n:xt-past ( if different E-Mail rfbrouDi unocIC a ffrona^A` Con4
from the Owner listed above)stateorc¥untyLicense Jr`Aft , rBl 473Iq\-'-
lf 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.
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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:Gty:
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.
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n consideration of the granting of thi.s requested permit,I do hereby agree that I will, in all respects, perform the work
n accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The following bui ding 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 T0 OWNER: YOUR FAILURE T0 RECORD A NOTICE 0F COMMENCEMENT MAY RESULT IN YOUR PAYING
TWICE FOR IMPROYEME NTS T0 YOUR PROPERTY. A NOTICE 0F COMMENCEMENT MUST BE RECORDED AND
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REVIEWS FRONT
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LANS VEGETATION SEA TURTLE MANGROVE
REVIEW REVIEWCOUNTER REVIEW REVIEW REVIEW REVIEW
DATERECEIVED
DATECOMPLETED
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