HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: . G �DlFbPermit Number.
Building Permit Application
Planning and DeuelopmentSendces
Building and Code Regulation DNIS10n;
2300 Virginia Avenue, Fart Pierce FL 34982
Phone: (772) 452-1553 Fax: (772) 452-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dmpbox. click arrow at the and of line
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Address: ZOr�,r k U� QC)C/-
Le I Description:— J
Ch a n6 � 0'.4- Com• k -e 4r (-e k e- , I- !-,ACL 4-e c4- 1 TD -J"- ' E V,) A -U - Lt rl 1-T-;
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Address: hn vn l
City.,/-State—TT.)
Zip Cade:
Phone No. o - S -.-) U r b
E -Mail. 1`3 1+4
Fill in fee simple Tile Holder on next page ( if different
from the Owner listed above)
Address: S" !Yarm Lvg _
City: 4 lG - State:�Ce..
Trp Code:9�a Fax:-y1�51t194'
Phone No. 7rg
E -Mail:
State or County Ucense: 9Ccle
if value of construcgan is $nOO or more, a BECCODW Notice of Commencement is rewired.
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M51GNERIENGINEER: Not Applicable
Name:
Address:
City: State:
Zip Phone
FEE SIMPLE TITLE HOLDER: Not Applicable
Name.-
Address:
ame.Address:
City:
Zip: _ Phone: _-- —
MORTGAGE COMPANY: _ Not Applicable
Name:
Address;
City: State:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
Zip: Phone:
OWNER/ CONTRACTOR AFFIOVIT: 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 ofa permf t
St Lucie County makes no representation that is granting a permit will authorize the permit Balder 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 Horne 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. Lude County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, watts, 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
com mencigg work or recording our Notice of Commencement.
Rev. 812/17
7
Signature of Owner/ Lessee/Contractor as Agent for owner
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF `
STATEGER FLG A
COUNTY OF U,264M clzk CAU
The forgoing in merit was acknowledged before me
The forgoing instr_Went was acknowledged before me
this (p day of Lw,-- 20- by
this 6. day of 20_& by
r
Name of person making statement
Name of person makirig statement
Personally Known .)t OR Produced Identification
Personally Known;)_ OR Produced identification
Type of Identification
Type of Identification
Produced
Produced
(Signature of Notary i
(Signature of Notary Publi
DANE. EiELL
co #GG
A- y, DONNAM. "LL
M'MION#GG099038
Commission N r me
Commission N r
r ;...�,'SwdW7hmN tar Rdircum
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fmi moi' ui€dsiwdteis
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 812/17