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HomeMy WebLinkAboutBuilding Permit ApplicationSUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: MATION: DESl,GNER%ENGINEER: Name:---,,, Address: City: Zip: Pha�i I C FEE SIMPLE TITLE HOLDER: Name: Address: City: Zip: Phone: Not Applicable MORTGAGE COMPANY: Not Applicable State: Addl City: Zip:_ State: of Applicable BONDING COMPANY:`,-".., Not Applicable Address: City:, Zip: OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain —a - permit to do the work and instal�asln. 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 ancovenants 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 pians, 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 n YOUR LENDER O N 707 1EY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." tip i - Signatu of Owner/ Lessee/Contr'actor as Agent for Owner Signature of Con /License Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OF Oai'Y� COUNTY OF M /� i The forgoing instrume was ac nowledged before me this Z"Zday of 20 2a by Name of person making statement. Personally Known OR Produced Identification-" I Type of Identification (Signature of Notary �Publi;'State of Florida I CC Co fssion No. �—y'� tpsrv�a N_o ry Public State . FI< t° `'t SgIrmin D Walke My Commission GG 2 ;_- Expires 06106!2022 .00 REVIEWS FRONT ZONING SUPERVISOR COUNTER REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev._f'7T1 —_— - — The forgoing instrument s ac wledged before me this Z7 day of 20a by f Name of person mak g statement. Personally Known_ OR Produced Identificatiorr--, f 1` � 1 nature of Notary Public- ate of Florida) mission No. Nota4$eao state of Florida Charmin D Walker N • q My Commission GG 225827 os F` xp1,rec77,6X7et'-'22-- PLANS VEGETATION O REVIEW REVIEW REVIEW REVIEW All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED � Date: � � ' 2,0 O Permit Number: Building Permit Application Planning and Development services Building and Code Regulation Division 2300 Virginia Avenue, fart pierce FL 34982 Phone: (772) 4.62_1553 Fax: (772) 462-1578 Commercial PERMIT TYPE: _ /*� Residential s (?P�tE }IFpRti�J(ETlt©'CATtQ'tw Address: a + Property Tax ID #: 10. &LotO?Site Plan Name: d �� �, No., Project Name: Block No. L a 'DEtAf'LED DESCRIPTION OF' -W Rk; ov u Ew oe wG�4s -oN/V«T F_ p t1AQ CONSTRUCTION INFORMATION: Additional work to be perforrlyed under this p7Gas check all that apply: _Mechanical _V�bas Tank i in _ p g Shutters _ Electric _ Plumbing _ Sprinklers — Generator Total Sq. Ft of Construction; Sq. Ft. of First Floor: Cost of Construction: $ Utilities: _ Sewer Se_ _ ptic ..,�'rv�rCrs('tt�Jtts . Name . F, i Addres • p City:o�'t� S`r- . Zip Code: Fax: Phone No.jAf)--- YL p , State: F Fill in fee simple Title Holder on next page ( if different from the Owner listed above) If value of If value of "A*i Cr ,;WNTRACTOR' _ Windows/Doors Roof Pitch Building Height: Name: Af f►% % ,L Company: 04 [" N Address: sol-AgAr,J %dw City.Stater Zip Code: ��/Q 4 Q Fax: Phone Not - �i.i • ZG�' E -Mail Y. t State or County License O Notice of Commencement is req of Commencement is required. 'JotI My VM1100 C