HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INF0 MUST BE COMPLETED FOR APPLlCAT1ON TO BE ACCEPTED
Date;
'.�
Xannr ng arMor.DevOopment Services
Permit Number,
Building Permit Application
Svil.ding and Code Regulation Div ston Commercial Residential
2300 Virg;rMia Avenue, Fort Pierre FL 34-982
Phone: (772) 2-1553 Fax,. (772) 462- IS 78 CBDG Fu I'1d ting
PERMIT APPLICATION FOR:
-PROPOSED I PROVEI FNT LOCATION'. -i
Address: 'mo
Pro pe rty Tax I D 6 o 1 Y) — Lot No.
Site Plan Name, Block No. -
Project Nam@: _....
DETAILED DESCRIPTION OF WORK, �
{ r ~P o4
New Electrical Meter Second Electrical Meter_ (Affidavit required)
CONSTRUCTION INFORMATION:
Art d ition al work to b e perfo rme d under this permit —check all that apply:
Mechanical
_ (3a:� Tank
� Gas Piping
_Shutters
W1ndows/Deors
� Pond
Electric
— Plumbing
_ Sp riff kle rs
_ Generator
Roof
Pitch
Total Sq. Ft of Construction,
Cost of Construction:
OWNER/LESSEE:
Narn
i
Sq_ Ft. of First Floor:
Litil i tles: —Sewer _Septic Building Height:
.address:
Cat': n state'
Zip Code: Fax,-
Phone No. — i Z 7E-
Mail- l.1
Fill i n fee si m pie T it0e Hol d er on noxt page � i f d i ffe rent
from th a Ow n er l iste d above)
COI TRACTO :
Cornpany: t- t f'j r c f to Mid r
Address, I pi i eb L Jea5 4 -, L erz V-r
City: #' r } + fly _ state: x
Tip Code: 1 Fax: 4� �
if value of construction is 25DO or more, ;a RECORDED Notice of tomrnencement is required.
I f va lue of HAVC is $7,500 or morer a R FCOR DE D H otice of Commence m e n t is req aired.
SUPPLEMENTAL CONSTRUCTION LIEN LAIC INFORMATION:
DESIGNER/ENGINEER:
Not Applicable
Name;
Address:
City; State=
zip: Rhone
FEE SIMPLE TrrLE HOLDER: )�Not Applicable
Name.;
Address -
City,
Zip- Phone:
MORTGAGE COMPANY:
Name:
,add rez,
City-
zip•
Phone:_
ot Applicable
State -
BONDING COMPANY: Not Applicable
Name:
Address:
City,
Zip- Phone:
OWN ER/ CONTRACTOR AFFIDVIT: APPlication i5 hereby made to obtain a perrnit to do the work and installation as indicated.
I certify thi3t no w-Drk or installation has commenced prior to the issuance of a permit -
St. Lucke County makes no representation that i ranting a permit will authorize the permit holder to blui1-d the subject structure
which conflicts with any applicable H�meowners Association rul-es, bylaws or and covenants that may restript or prohibit sunh
structure. Please consuIt with your Homeowners Association and review your deed for any r-estrictions which may apply.
I n consideration of th a wanti ng of this requested pe unit, I do hereby -agre-e that I will, in all respeCtsr perform the worm
i n a ocorda n ce with the a p pr-oved pl ans, the Florida 0 u i Iding Codes a nd St. Lucie Cou my Arnendm a nts,
Th e f-o I I owi ng b u i Icing permit app licatio ns are exem pt fro rn undL-rgo i ng a full roncu rrency review; room additions,
a-ucessory structures, swimming pools, Fen-CeS, walls, signs, screen rooms and accessory uses to another non-residential use
WARNING TO OWNED: Your failure to Record a Nice of Commencement moy result in Paving twice far
i rn prove me fts to your property. A Notice of Commencement must be recorded in the public records of St.
Lure County and posted on the jobsite before the first inspectlion, If Vou intend to obtain financing consuIt
wit h I ender or a n a tto rney befo re co rn me roc i ng work or record i niz you r Notice of Corn m ence ment.
Signu ure of own r/ L.s&e�f ntn�ctor as Agentfor Owner
STATE OF FLORID
CCUUNTY OF r.;
sworn to (or affi rmed) a n d s u bscri bed before me of Physical Presence cr O n fine Notarization
this la -Imo -ay of ,+ h . 20 _1 by
N a M E, Of Pe rsO n ma king �tatome nt,
PersorsallV Known 0R Produced Identification
Type of Identification Produced
e of Notary Public- State of Florida)
Commission moo d u JENNAL. FMCO
1P` ` fi rt��5 l r+# GG320
i' oarsslUriuo *Eqlm Apr@ n.
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