HomeMy WebLinkAboutBuilding Permit Application 1 1 1 11 1 1 11 11
All APPLICABr • MU ST BE COMPLETED FOR APPLICATIONTO BE ACCEPTED
Date, •-
��•-- � � RECEIVED
Building • t t t JAN Planning and Development Services i
•-..
permittinr
Building and Code Regulation Division St.Lucie countv
// Irtryinia Avenue,Fort Pierce FL 34982
Phone,(772)462-1553 Fax:(772)462-1578 Commercial Residential
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Name:
•♦ Company:
w
FICA mi �
if value of construction is
r
. . i
01 or more,a RECORDED Notice of Commencement is required.
value $7,00 or more,a RECORDED Notice of Commencementrequired.
10/02/2038 05:54 #1501 P. 002/002
l
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: 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.
i
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 anothernon-residential use
"WARNING TO OWNER:YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING
TWICE FOR IMPROYEMiE1US TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED OA THE JOB SITE BEFO TIE FIRST INSPECTION. iF YOU INTEND TO OBTAIN CIINC, CONSULT
OR AW ATY0ANEY BEFORE RECORDING YOUR NOTICE OF CO A
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Sign re of Owne/Lessee/Contract r as AoAt for Owner Signature ofContrfetor/IJcense Holder
STATE OF FLOR%je, �, STATE OF FLORIDA
COUNTY OF u- ^ COUNTY OF
The f rgaing instrument was acknowledged before me The for tog instr ent was ac cnowledgP,fl_before me
this day of .20- by this Lo y Cu.c+-a,� 20_Q by
Name of person making statement Name o person maksAg statement
Personally Known OR Produced Identification Personally Known OR Produced Identification II
Type of Identifi at'on Type of ldentifi t' n
Produced Produced
I
(Signa of Notary Publi -State f Florida) (Si tary Public-State Flo(Ida)
Commission Nov KJ� (Seal) Commission No. m (Seal)
REVIEWS FRONT ZONING SUPERVISOR PIANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
BATE
COMPLETED
ev.2/7/19
PACE L.JARRiEL
'-
PAGEL.JARELF9
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