HomeMy WebLinkAboutBuilding Permit Applicationzauu VuYlf77u t Vu' uG, r yr
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
Address: fq q 0 L -
Legal Description: 9ev
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Oak
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Property Tax lD #: N36 - 60),– 0001 --- 000– 7
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side:
up- ON
Additional work to be pertormed under
Mechanical — Gas Tank
4 Electric _ Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ gc3i)
permit – cnec
_._. Gas Piping
Left Side:
apply:
_ Shutters
_ Sprinklers _ Generator
Sq. Ft. of First Floor:
Utilities: _ Sewer _Septic
V
GLK 1
Lot No.
Block No.
Windows/Doors
Roof
Building Height:
Name ,� � � ���
Name:
.
Address: 4 D(Cl iO4= Z):"
Company:
T ver M c;,
419 Pf
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( C41
City; j + . Ars State:/°`�-,
Address:
-1
X -
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State:
Zip Code: 3Lt941 Fax:
Phone No. ' '�`{� " �� rn
City:
Zip Code:
Fax:
l E -Mail:
Phone No
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01 4
Fill in fee simple Title Holder can next }sage (if different
E -Mail
from: the owner listed above)
State or County Licensee
if value of construction is 2SOO or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER:
Name:
Address:
City:
Zip: Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:
_ Not
State:
_ Not Applicable
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
Not Applicable
State:
Not Applicable
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.
In consideration 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.
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 lender or an attorney before
commencing work or recording our Notice of Commencement.
ature er Lessee/Contractor as Agent for Owner Signof actor/License Holder
STATE OF FLORIDA E OF FLORIDA
COUNTY OF%-uCCOUNTY OF
The forgoing instrument was acknowledged before me
this jYr`day of OLM)-cr 20/4
by
(Name of person acknowledging)
(Sig �ureofotary Public- State of Florida
Personally Known Y� OR Produ
Type of Identification
Produced F4
Commission No. F -qrb 55(lf,
The forgoing instrument was acknowledged before me
this day of L Cit; b�t'' , 20/ by
(Name of person acknowledging)
'.nature of Notary Public- State of Florida
-in Personally Known OR Produced
Type of Identification
Produced
Commission No. 1? 6
REVIEWS FRONT ZON�Sd�dP RVISOR
COUNTER REVt T fRE IEW
t DATE a _!
RECEIVED s I z
DATE o "
N N
COMPLETED , a
tev. 712014 - —
PLANS VEGETATION SEA TURTLE
REVIEW REVIEW REVIEW