HomeMy WebLinkAboutBuilding Permit Application . 1 ` . ` 1 •.. •s � s � lil i � ��
ALL • MUST BE COMPLETED FOR APPLICATIONTO BE ACCEPTED
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Date,
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RECEIVED
Planning ar Development
PERMITTING
Building and-Code Regulation Division St. Lucie q0unty, FL
11 Virginia Avenue,
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residen
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SEP-29-2017 FRI 03:39 PM CENTRAL SCHEDULING FAX No. 3212686138 P- 003
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DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: T Not Applicable
Name: Name:
Address; Address:
City:_ __ State: City: __ —State:
Zip: Phone _...----'.__-- Zip; Phone:
FEF SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: Not Applicable
Name: Name,
Address: Address:
City: _ City:
Zip: Phone: Zlp: Phone:
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 represenRtation that is granting a permit will authorize the permit holder to build the subject structure
whlch Is in conflict with any appllcahle Home Owners Association rules,bylaws or and covenants that may restrict or prohibit such
structure.Please consult with your Home Owners Assoclatlon and review your deed for any restrictions which may apply.
in consideration of the granting of this requested permit,I do hereby agree that l 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,
accessary 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.
Signatur of caner/Lessee/Contractor as Agent for Owner Signature of ont actor/License Holder
STATE OF FLORIDA �Q� I a STATE OF FL RIDA
COUNTYOF HJT, I �vu,l � COUNTY OF %� 01 CA
The f oing instr a as acknowledge before me The f oing instrul t w s acknowlecl d before me
this day of 2Q�.by this day of 2fi1 by
Name of persa making statement Name of person making statement
Personally Known �___ OR Produced Identification Personally Knownil'c' OR Produced Identification
Type of identification Type of identification
Pr duced Produced ^
(signature of Notary Public-5 E,lor (Signature of Notary Public-State � oda)�herine Kortger ' Y Catherine Konger
. .! ;C ou#FP1y2372 . I
Commission N �� -Commission No. - � ` ,. C ion#FF172372
� ° p res;OCT ze,zo18 , Explres.OCT 28 Zp18
BONMEOTHBU s
1$T FLORIDA NOTARY,LLQ r"r•OiBju •` 15T FLORIDA NOMTARY=
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
• Rev.8/2/17
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