HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date. Permit Number,
slag
Building Permit Applicati n
Planning and Development Services 0,
Building and Code Regulation Division
2300 Virginia Avenue,Fort Plefre FL 34982
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Resident al
PERMIT APPLICATION FOR:
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PROPOSED INPROVEMENT
Address:
Legal Description:
Property Tax 10 00- a-5-
Lot Na.
Site Plan Name: Block No.
Project Name: 111_194�2�
Setbacks Front Back:_Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
A(lditional work to be per tormqd underth—ispermit–cliecka apply-
CIHVAC UGas Tank []Gas Piping U Shutters! El Windows/Doors
[ Electric Plumbing Sprinklers FlGenerator Roof
Total Sq.Ft of Construction: Scl.Ft.of First Floor_
Cost of Construction:$ utilities: Sewer
QSeptic Building Height:
OWNER) SEE: CONTRACT
Name_ HJ(dl,, Name:
Add
re C75 Company:
City. State Address: ct�24//
Zip -*
Code city: S t a t e.,2
Phone N0-
M� J Fax:
E-Mail. Phone No.
[Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License,-
If value of construction is$2500 or more,a RECORDED Notice of commen t-I
comen is required.
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SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNS ENGINEER: _Not Applicable iVIORTGAGE COMPANY: ,Not Applicable
Name: Name:
Address: Address:
City: Stater City: State:
Zip: Phone: Zip: Phone:
I
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name: I
Address: Address:
city: city: i
Zip: Phone: Zip: Phone:
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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.i_ucie County makes no representation that Is granting a}hermit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Nome Owners Assoc ation 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 jail respects,perform the work
in accordance with the approved plans,the Florida Building Codes and St.Lucle County Amendments.
i.
The following building permit applications are exempt from undergoing a full cont rency review:room additions,
accessory structures,swimming pools,fences,walls,signs,screen rooms and acc s ry uses to another non-residential use
WARNING TO OWNER:Your failure to Record a Notice of Commencem may result in y ur paying twice for
improvements to your property,A Notice of Commencement must a ecorded a d p sted on the jobsite
before the first inspection. If you intend to obtain financing,consult i h lender an ttorney before
commencing work or recordingyour Notice of Commencement.
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Signature of Owner/Agent/Lessee Signature of co crfL1 en older
STATE OF FLORIDA STATE OF FLO
COUNTY OF COUNTY OF
The forgoing instrument was acknowled ed before me The f r oing Inst u a ovule d before e
this, day of .20�by thi�day o zQ by o
a
Q
�M1w. o
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(Name of person acknowledging) (Name of person a nowledgirig) C '
9r
T �
(Signature of Notary Public-State of Florida) (Sign of Nota Public-State of Florida jw
Personally Known r..�OR Produced identification _ Personally Known OR Produced Identification
Type of identification Produced Type of Identificatio Produced
Commission No. (Seal) Commission No._ _ (Seal)
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Revised 07/15/2014
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DATE
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DATE
COMPLETED