HomeMy WebLinkAboutBuilding Permit Application ALL APPLI LE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: A
Permit Number:
RECEII"D JUL 19 7.016
Bui9flfig' Permit Application
Planning ane Developrnent Services
Building and Code Reguiation Division
2300 Virgins Avenue,Fort Pierre FL 34982
Phone,(77: 4621-1553 Fax;(772)467-1578 Commercial . Residential
PERMIT A PLICATION FOR: To Select from dropbox, click arrow at the end of line
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11111101111 IN
Address:
N. x., wr
Legal Descrip �on.
PropertyTax• #•
Site Plan Na - --.� Lot No
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Project Name Block No.
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Setbacks F nt Back: R,ght Side: ^Left Side:
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Add[ 10 WIQ r to e e orme un er IS perm t—c ec a app Y: " ' °``:': •:
HVAC Gas Tank Gas Piping _Shutters E]Windows/Doors'
Electric Plumbing Sprinklers Generator Roof
Total Sq, Ft of onstruction:_DIl_ll S .Ft.of First Floor:
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Cost of Constr ction:$ Utilities: Sewer 17 Septic Building Height:
Name
Name:
Addre Company:
City: : �. - ate: Address:
Zip Code: Fax;_ City,-
Phone
ity;Phone No.= Zip Code: Fax• � .[( �f
E-Mail: Phone No. • L
Fill in fee limp e Title Holder on next page(if different E-Mail.
from the Owni r listed above) State or County License "?
LUL
of con uction is$2500 or more,a RECORDED Notice of Commencement 15 required. I
DESIGNER/E GINEEIR' ;Not Applicable MOOGAGE CdMPANY: T�Not Applicable
Name: Name;
Address: Address:
City: Stater City: state:
Zip: Phone; Zip: Phone:
FEE SIMPLE I. ITLE HOLDER: Not Applicable BONDING COMPANY: , Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
I certify that ne work or Installation has commenced prior to the Issuance of a permit,.
St.Lucie Coun makes no representation that is granting a permit will authorize thermit holder to build the subject structure
which Is in con ct with any!applicable Nome Owners Association rules,bylaws or and covenants that may restrict or prohibit such
structure.Pleas consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideraticii i of the granting of this requested permit,I do hereby agree that I will,in all respects,perform the work
in accordance th the approved plans,-the Florida Building Codes and St.Lucie County Amendments.
The following b ilding permit applications are exempt from undergoing a full concurrency review:room additions,
accessory strut ires,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use
WARNING T i OWNER:your failure to Records a Biotite of Commencement may result In your paying twice for
imp ovemen to your property.A Notice c►€Commence ant must be recorded and posted on theobsite
be f a the fi t inspection. If you'ntend to obtain financi ,consult wit lender or an attorney before
tom. ehcin _ din r Notice of Comm enc . ent.
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STAT OF F RIDA / �i�Qi�,
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COU C) - �_J� t 0031E 0 QFO �
The�ing in t ume t was acknowledged before me The f� ng Inst meat wa acknowledged before me '
this day 20 ibq this day of 7� _,2e.lfty
N.
(Name of Pers 'acknowled ! } (Name of pemin acknowledgin
0921
gnat
ure of to Public•state of Florida) (S' tura of Notary il
`�,�,�` JfRALYNNE RUSSELL
�'{ Y A' 6 Persona!! Known « tdprc�d,liii+saksauf F►ar,4a
Personally Kno �R ProleR� von Y
Type of ldentifi _~ etfotar Puht; _ Type of ldentiflcatio << � d'a= M Comm.Ex ices Jul 22 2017
My Cama, 8xplres Jui 22,2017 e� Commission#FF 058392
Commission N °". is�io�S�a 1038392 Commission No.
Revised 07/ :5/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MA14GROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPL!TE
INITIALS