HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONf
'All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: 110 cc °
By
Building Permit Application
Address: / o! U 45 /r'0/9-/c�
Legal Description:
I
Property Tax ID th c� o �' 00 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
CON5T.RUCTION 1N 0RN ATIQN
AdditionaiworKtobepertormedun er t is per t — c ec a that apply:
_Mechanical _ Gas Tank Gas Piping _ Shutters _ Windows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction:
Cost of Construction: $ Cg3
c90
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic
Building Height:
01lUNERf
.
P TRACTOR ':
Name 21 IJ
Name:
Address: 1,Ao ?1_12G�Pd? U�OGiLI,
Company: �!i r�
/�7 64114100
City: 1�, of lelec to State:
::Address:
Zip Code: ;Fax:
L,.'s,,..C,ity:.'ebr�/�2�
Statel�l
Phone No i ....;�.`Zip
Code:
Fax: ��.� .79i� IOU
E-Mail: r
Phone No 6_3 G
Fill in fee simple Title Holder on next page ( if different
E-Mail _9`e uo
r�
from the Owner listed above)
State or County License
3oi S7S5—
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: _ Not Applicable
1►FriiT2
Address:
City.. State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
'N'ame-
Address:
City State:
s:
Zip'. Phone:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
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.
Inconsideration 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 plans, the Florida'Building Codes and St. Lucie County Amendments.
L
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 jobsite
before the first inspection. If you intend to obtain financing, consult with len er or an attorney before
commencins work or recordine your Notice of Commencement.
re of Owner/ Lessee/Contractor as Agent for Owner rya6re of"Contractor/License Holder
STATE OF FLORIDA 11 STATE OF FLORIDA <71
COUNTY OFCOUNTY OF
The forgoing instrument was acknowledged before me
this day of 20A3 by
IFAAP
(Name of person acknowledging)
(Si ,2tu,r,d o&Notary Public- State ofT%%)rida )
Personally Known OR Produced Identification
Type of 1dentification
Commission No
FRONT
CO U NTE
:E ..
EIVE
COMPLETED
The forgoing instru ent was acknowledged before me
this ay of 20Y,— by
(Name of person acknowledging )
N'tgKature of Notary Public- St a of Florida )
Personally Known OR Produced Identification
Type of Identification
Produced
EW
gR�ugN�NNgAo
1.'§0103of
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