HomeMy WebLinkAboutBuilding Permit Application 06127A2016 13:43 7724621578
ST LUCIE CO IMPACT PAGE 03/03
All.APFUCA INF MUST BE COMPLETED FOR APPLICATION TO 6E ACC W
Date:I - Permit Number:
R'ECEI` .. L) JUN 2 -3 2016
Bundling Permit Application
Plattniag and Development Sewvkes
Building and Code Regulation l3rVlslvn
2300 Whainin Avenue,Fort Pierre FL 34982
Phone:(77Z)462-1553 Fax:(772)462-3.578 Commercial ., Residential
PERMIT APPLICATION FOR-.,To Select-from dropbox,click here
PROPOSED INPROVEME I.tC4TION:' -
Address. -
LegalDe'
RNV—
Pr
' tion
UNopTax ID,#:
site plan Name.• Block rico.
Project Name:
Setbacks FrontBack: Right Side: — Lett Side: -- —
DETAILED DESCRIPTION OF WORK: h
CONSTRUCTION INFORMATION:
Witiona wor a orm a an art is permm-check all app :
HVAC Gas Tank GDS Piping InShuttem. Windows/Doors
Electric Plumbing Sprinklers InGenersror �Roof
Total Sq:Ft of Construction: 4 6 15 Sq.Ft of Firstnseptic
0r:
Cost of Construction:$ i i ' T Utilities: sewer Building Height,
1WNF SSS : t CONS OR.
Name dame:
Addy a / Company:
city State:i�i Address-
Zip Cade: Fax:
Phone NO. � Zp Code: � Fax:
E-Nati• Phonei�it� L1 - 1C
Fill in'Pee simple'Cttle Holder on next pao(if different E-Mail:
front the Owner listed above) State or County Ucense: 1
11vaiue ar guastructtcm is$2 00 or more,a RfORDED Nanta of commanoa eEnt Va rog4md.
06/27/2016 13:43 7724621578 ST LUCIE CO IMPACT PAGE 02/03
SUPPLEMENTAL CONSTRUCTION UEN LAW INFORMATION:
QES# NER/lGNGINEER: NatAp Iicab a MORTGi4G OMpANY; Not Applicable
Aflame: Name:
Address: Address:
City: Stare: City: state:
zp:.�.-Phone: Zip: -- Phone:
FEE SIMPLE TITRE HOLDER: _Not Applicable BONDING COMPAW: Not Applicable
Name: Name:
Address- Address;
c-ay:
Zip: ,_Phone: Tap: Phone:
OWNEIrIJ COINTRAMR AFFIOMT:Application is hereby maado to obtain a permit to do the work and installa4Gan as Indicated.
i certify that no work or Instailation hes commenced prior to the Issuance of a permit
�,Lucie Ddut�r makes no repro entatioi�that is granting a permit velli a�uthdrlxe the permit holder to build the subject structure
WIA lah is In conflict with anyy a�pp cable Home Owners A3saciation rules,k�ylaws or and covenants that may re �t or prohibit such
structure."Please cahsult with your Home Owners Association and review your deed for any restrictions whic�may apply.
in eonslderstlon of tte gtantiing of this requested permit,i do hereby agree that I will,In all respecrs,perform the work
in accordance with the approved plans,the Florida Building Codes and St.Lucle County Amendments.
The fcllowin unding permit applications are axon not from undergoing a full eonwerency review:room additions,
accessorysoupures,swlrnmine pools,fence$,walls,signs,screen roams an cessory uses to aatather non-res'rdentlal uare
WARN#N OWNER:Y rfailure to Recor el a Notice of COMM dairnent may asult In your ping i www fbr
I rove aV.,,
your ra rty.A Notice of Commencement u t be re red and posted on the jobsite
before th fspezt n. you intend to obtain finandng,c qs It with tiri er or an attor_p �befbre
commencink d rt
rding your Notice of Ca menceme
IS
�ature of a A8 tJ Signature Contra 11.lceMe Holder
r7:��
TATIR OF F RI STATE 0 LORI
COUNTY OF tv COUN'�tf r
a�lltlf/,�
The f Ing In ant s ackn' before me The f mprig i ru ear was aacknevdled ed before y�
this9rday Z0 by tt,is rsd day 20 bt v
all
(Na of P ocknowledging) Sa aarne of p on acknouuledging) ° as
a
l5 of Mots Public-Stare of Florida) s e tore of>V$iaary public-State afi rlr3a)
Personally Known 4R pitiadasced Idenfifca ersonally 1(nawtr5flR Produced IderaSflcati n..—$M
Type of ldentificatio Produced e of Identificati; Rroduced a
T
Commission No. (Seal) =
o s Colranai5slon No. (Seel)
mQ
�Y
Revised 07115/2014
REvlEws FRONT ZONING SUPERVISOR PLANS VEGETATION SEATUATLE MANGROVE
COUNTER REViEW REV)EW REVIEW REVIEW REVIEW REVIEW
DATE
REGBIVED
DATE
COMPLETED