HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO : I
Date: Permit Number.,
Building Permit
Application
Planning and Development Services
Building and We Regulation Division
// Virginia Avenue,Fort Pierce FL 34982
Phone. {. • Residential
ERIVI] APPLICATION FOR: To Select from dropbox, click arrow at the end Of line
Legal
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Description:
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Name '' 'i. '. lQa,-t
Address- W,,
city:. State: .•
Code;Zip M ..
Phone No.
., �.
Fill In fee simple Title Holder on next page(if different
from the Owner listed above)
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St1PPLENiENTAL CaNSTRUCTION LIEN LAIN INF.iJRMATIQ,N
DESIGNER/ENGINEER: Not Applicable MORTGAGE COIVIPANY:, ; Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:J
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: I'1� 1 Not Applicable
Name: Name:
Address: Address: !?
City City:
Zip: Phone: Zip: ,Phone:
1 certify that no work or installation has commenced prior to the issuance of a permit.
i
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:i 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 of an attorney before
commencing work or recording our Notice of Commencement.
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Signature of Owner/Lessee/Contractor as Agent for owner Signature of Contractor License'Holder
STATE OF FLORIDill STATE OF FLORIDA
COUNTY OF >1.c COUNTY OF - -
The forgoing instrument was acknowledged before me The forgoing Instrument was acknowledged before me
thlsj�_day of , 20 by this, day of - 20 V by
r�
(Name rson acknowledging) (Name of person acknowledging,)
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Ognatule ofWtary Public-State of Il} (§gnsfurJ of Notary Public-Sta Florida}
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of identification).;ro„duced J
4 4 {Faun i,
Commission No.. r.,,.. (Seal) Commission No.
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