HomeMy WebLinkAboutBuilding Permit Application IF
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Building and Code Regulation D dip
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2300 Virg Avenue
inio Fort pierce FL 34 S
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Phone : ( 772 462�155 F
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772 ) ' 462 ' 1578
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PERMIT APPLI
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CO'NTRA ORIP
. OWNE ESS E .
Name
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Address i t . Oft
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ZI Code . ?low Fax,,
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State
hone No. 4�4
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HIM
MENNEN=
E�Mai* l . -9 Pho e No
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Lood,
F InSIMP rent E-1-Ma1* 1le le Holder on next ame
'011 'D ee rom the C)wner I d a bove) coo��
State or Coun
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0 MU T BE CDMPLETED FOR APPUCATION OBEA CEPTED
ST LUCIE
B lid 9 P t APPI
C M R d t 1
2
3 ax
CAT
Icense
if value constru n is 2,W or more,, a RECOFtDED Notice Of COrnnienceme Is
uIred ,
M
i
PIN -47
UPPLEMENTAL CONSTRUCTION LIEN LA'W INFORMATION : �:
DESIGNER/ ENGINEER: � Not Applicable MORTGAGE COMPANY: Not Applicable
Name : Name : Y
Address : Address :
cit - state City
y : atee
Zip : � Phone � Zip : Phone .,
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING .COMPANYS Not Applicable
Name : - Name :
Address: Address:
City :
Ze
i p : P h o n e : Z'19 p: Phone .
IP
OWNER/ CONTRACTOR AFFIDVIT: Application i s h ere by m a de to obtai n a permi t to do the work a nd i 11ation as indicated.
certify that no work orinstallation 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 str ucture �
which is in cor�flid with any applicable Home Owners As�ociation rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult vath your Home Owners Association and review your deed for any restrictions which may apply.
I n co n s i d eration of th e gra nti ng of this req uested permit, I do h e re by agree th at I will, in all respects, perform the work
accordance with the approved plans, the Florida Building Codes and St Lucile County Amendments.in .- ,
The following building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures, svnmming pools, fiances, walls, signs, screen rooms and accessory uses to another non-residential use
WARN ING TO OWNER: Your failure to Record a Notice of Commencement may resu K in paying twice for
improvemen tsto y our property. A Notice of Commencement must be recorded in the public records of St.
Lucie County and posted on the jobsite before the first inspection . If you intend to obtain financing, consult
with lender- or an attor e before commeric work or recordin your Notice o ommencement .
r a
C/
gnature of Owner Leewee/Contractor as Agent for 0 er Signature of Contra ctor/lice nse Holder R. r
STATE OF FLORIDA STATE OF FLORID
COUNTY OF SAIAI j PLC � COUNTY OF � AS T
Swor to (or affirmed ) and subscribed before me of S or affirmed .) and subscribed before me of
i I Presence or Online Notarization by
Ph srcaf Presence or Online Notarization�this day of by this � day of -2@30 . V . . . �
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Name of person making statement. Name of person making state ent
Personally Known OR Produced Identificat! Personally Known OR Produced Identification�_
ype
ype of I de ntifi ca n _ - T of Identification
Produced '�i � l goo Produced �,. �r op d �-Is �.:
(Signatureof Notary public- S THY J. MERSHOP�'H�OR nature of Notary Public State ot 1�
tjQtary Public.) State of Flo da + p� d• MERSHOhkHENDRICKS
sion» GG 298a9 � mission No. � $� hNQ� 1'� blic, State of Fbrida
miion No altommis �omnr sionN Gu 298r95
My Comm. expires Feb. 120 23 a 1; 91* Cy $I"
My comm. expires Feb. 12, 2023
REVIEyys FRONT ZONI NG SUPERVISOR ' PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVI EW REVIEW REVIEW REVIEW REVIEW
RECEIVED 4
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