HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1�1 a.a Permit Number:
RECEIVED
Building Permit Application
Planning and Development Services JAN 17 2020
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 ST. Lucie County, Pe itting
Phone: (772)462-1553 Fax: (772)462-1578 . Commercial ReSI entla
PERMIT APPLICATION FOR:
PROPOSED;
SUPPLENTAL CONSTRUCTION LIEN I;AW INFQRMATIt ,N
ME
pp
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.
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
commencin work or recording our Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent.for Owner Sign ,cure of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF S3-,1—,hoz -R
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this V) day of -7 g r 20'4,a by this \Z day of 5 a 120V-) by
� 6\b,4' d)r,-0, \,D-Irk
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary I@blic-State of Florida) (Signature of Notary ublic-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Ident* al*a
Type of Identification Type of Identification_,w_, '—
Produced Fir C- Produced DEANNAMARIEGNENS
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DATE
RECEIVED
DATE
COMPLETED
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