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ALL APPLICABLE IN I UST OMFt£TED FOR APPLICATION TO BE ACCEPTED
Date: ' • Permit Number:
Building Permit Application
Planning and Developn6t Services
Building and Code Reg.
ion Division
2300 Virginia Avenue,Pierce FL 34982
Phone: (772) 462-15s� Fax: (772) 452-1578 Commercial Residential
To Select. _.._. _ __ ........ i
from dro box, click arrow at
PERMIT APPLICAi�ON FOR:� p the end of line
Ci St ' A
Zip Co Fax: ` i State
Phone No.� A. Zip Code: Fax: •
Fill in fee simple Title Halder on next pa Phone No. •�'.�
p page ( if different E -Mail:
from the Owner listed covey State or County EicenseCAM AAL —
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if value of construction is $.2500 or more, a RECORDED Notice of Commencement is required.
DESIGN ER/ENGI NEEI :
Name:
Address:
City: 1
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Ph6ne:
I certify that no work or
Not Applicable MORTGAGE COMPANY: Not Applicable
Name:
Address:
State: City: State:
Zip: Phone:
— Not ApplicableBONDING COMPANY: TNot Applicable
Name:
Address:
City:
Zip: Phone:
has commenced prior to the issuance of a permit.
St. Lucie County makes nolrepresentation that is granting a permit will authorize theermit holder to build the subject structure
which is in contlict 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 gra ting of this requested permit, I do hereby agree that I will, in all respects, perform the work
in accordance with the aptiroved pians, the Florida Building Codes and St. Lucie County Amendments.
The following building per it applications are exempt from undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, wails, 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 record' >; ur Notice of Commencement.
Signature of Owner/ Agen Lessee Signature of Contractor/License older
STATE OF FLORIDA STATE OF FLORIDA n
COUNTY OF COUNTY OF
The fo m i t s wled ore me The o in instru t a a n led re me
this g day Y 20 r this of 20 y
(Name of on k owW, ding }
(Signature of Not Pub State of Flor da
Personally Known VIOR Produced Identification
Type of Identification Prod6ceedd
Commission N(F
.,
CRYSTAL MARIE CRUZADO
E9MM4SSinN # FF993217
Revised 07/150 ... EXPIRES June 25, 2020
(407)39"153 FlorldalloleryServka.com )
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COUNTER REVIEW REVIEW
DATE
COMPLETE
INITIALS
(Name of so acknowledging)
(Signature of Notary Pub ' State Flor � )
Personally Known 'OR Produced Idjentification
Type of identification Produced
Commission 32J
7Seai)
CRYSTALMARIE
MY COMMISSION # FF993217
OF ' EXPIRES June 25, 2020
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