HomeMy WebLinkAboutBuilding Permit Application ALL APPLICA:LE • MUST BE • 1 • ' APPLICATION TO : ACCEPTED
Daba: to Permit Number:
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Building1 001100
Permit Application
Planning , , Development Services JUN r 12 F
Building and Code Regulation
ii Virginia Avenue,
Phone: 4. 4.2-1578 Commercial Residential
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PERMIT APPLICATION FOR: To
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Site Plan Name, Block No.
Project Name:
Setbacks Front 'Back: Right Side
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tional work to bnerformed underthis�rtrrnit—cleclall apply:
HVAC Gas Tank as Piping Shutters OWindows/Doors
Electric Plumbing 01-prinklers E]Ggnerator Roof
Total Sq. Ft of Construction: S Ft of First Floor:
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Cost of Construction: �r ■ ■Septic Building Height:
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Zip Code: rinetH Fax:
HolderFill In fee simple title
from the • 17
e of construction is •1 or more,a RECOR:
id
DESIGNER/ENGINEER: _Not Apolicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
City: late;, City: State:
Zip: Phone: Zip: Phone:
I
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: I Address:
City: I City:
Zip: Phone: Zip: Phone:
I certify that no work or installation has commencE d prior to the issuance of a permit.
St_Lucie Count 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 ar 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 p rmit,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.
The following building permit applications are exe ipt from undergoing a full concurrency review:room additions,
accessory structures,swimming pools,fences,wall ,signs,screen rooms and accessory uses to another non-residential use
WARNING TO OWNER:Your failure to Reco�d 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 lender or an attorney before
commencing work or recordin your Noti of Commencement.
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' badS
_'Signature of Owner/Lessee/Agent ignature a Contra for icense Holder
STATE OF FLORIDA - STATE OF FLORIDA • r
COUNTY OF (� . U'i_Q, COUNTY OF •T C�'t_
The forgoing instrument wa acknowledged befor me The forgoing instrument was acknowledged before me
„z-
this day of 20 1S by this 1` day of C�USI ,20 L!5_by
ctr� 1�i- fral
(Name of person acknowledging) (Name of person acknowledging)
i
(sig ature ofotary Publ' S to o Fiorida) (Sign ure of otary Public-Si to of Grid
Personally Known OR Produced Identifica ion Personally Known . OR Produced Identification
Type of identification Produced Type of identification Produced
Commission No. ) Com 's 1 No, (seal)
Notary pub6 State o(Florida Notary(A1t11iC to.te of Florida
My Commies EE 848848 My CoMMISSion EE 948648
Revised 07/15/2014 t xptras Ivt if, � Expires�+rtz�xa�8
REVIEWS FRONT ZONING S PERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW l EVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
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