HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED q
Date: 1 5 Permit Number:
'RECEIVED
Building Permit Application JUL a
Planning and Development Services Lucie County, Permitting
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential X
PERMIT APPLICATION FOR: Window/door
PR`OP%Fb IM'' : VEMENT,10cATION .
Address: 159 Pepper Lane, Jensen Beach, FL. 34957
Legal Description: Lot 2 Bay tree
Property Tax ID#: 4511-503-0008-000/1 Lot No.2
Site Plan Name: Thoma Block No.
Project Name: Thoma
Setbacks Frontn/a Back: n/a Right Side: n/a Left Side: n/a
DETAILED DESCRIPTION OF WORK..`;
SUPPLEMENTAL CONSTRUCTION`LIEN LAW fNFORIVIATION
DESIGNER/ENGINEER: _Not Applicable MORTrAGE COMPANY: ,0 Not Applicable
Name: Name:,
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: 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 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
commencip0work or recolding yJbur Notice of Commencement. oolh
Sign esse on ra r as Agent for Owner Signatu Co er
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF ST LUCIE COUNTY OF ST LUCIE
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 7 day of JUNE 26A by this 7 day of JUNE 20Z? by
RUBEN F.ARROYO RUBEN F.ARROYO
Name of person making statement Name of person making statement
Personally Known X OR Produced Identification Personally Known X 'OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Signature of Notary Public- t* Moria gnature of Notary Public- to � *1 da)ANDREW GRAS
MY COMMISSION#FF998 5
FF998252 ? � ( IRES June 02,20 FF998252 '- COMMISSION#FF9 2
Commission No. c.,;,••' S C mission No. =�+
;e'��;d�' � 1�PIRES June 02,2
(407)398-0153 FbrldallotarySer&e.eom
(407)398-0153 FbrldalloleryServke.eo
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17