HomeMy WebLinkAboutMinorpermitappINFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Permit Number:
Building Permit APPlication
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fart Pierce FL 34982
Phone: 7nz) +oz-ts53 Fax: (7721 462-1578 Commercial- Residential+
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Address:IL
Legal DescriPtion:
Property Tax lD #:--l r-ot ruo. \ L
Block No.3n
Site Plan Name:
Project Name:
Setbacks Front-Back:
-
Right Side: Left Side:
Str4 (In\r
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RECoRDED Notice of Commencement is required'
prnn'nrr APPLICATION FoR: To Select from dropbox' click arrow at the end of line
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State or CountY
Fill in fee simple Title Holder on next paCe ( if different
from the Owner listed above)
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\GE COMPANY:
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Not Applicableffi
-
Not APP|icable
Name:
Address:
City:State:
Zip:Phone
MORTG/
Name:_
Address:
City:
-Zip: _
FEE SIMPLE TITLE HOLDER:
-
Not Applicable
Name:
Address:
BONDING COMPANYi
-Not
APPlicable
Name:
Add
City
ress:
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'
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structure. prease consurt ;'it"h,"i"ffH;rii; oi,;,;i;'hr'rfi''a-ti;;i;iiil';evi6w'v6iii Jeeri ioi-anv restrictions which mav applv'
ln 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 ,ppr."EJpi."i, irt'e iioriai Building codes and St. Lucie county Amendments'
STATE OF F
COUNTY OF
Name of Pqrton making statement
Personally Known \ On Produced ldentification
(Signature of NotarY Public-
ocI 28, Z01g
BONDED THNU
1ST TLORIDA NOTARY IJ.G
s acknowledggd,before me
-
2ol-h by
/ Lessee/Contractor as Agent for Owner
Name of Person making statement
Personally Known l* On Produced ldentification
Type of ldentification
Signature of Notary Public- S
Commission oqf 28,2019
BONDEDTHRU
1Sr FITmDA t{o1ARt, rLC
lYT8ffeforeme
SUPERVISOR
REVIEW
DATE
COMPLETED
Rev.8l2lL7