HomeMy WebLinkAboutBuilding Permit Applicationf
All APPLICABLE INFO MUST BE COMPLETEO FOR APPLICATION TO BE ACCEPTED l
Date: �� `� 1 Permit Number: 1 r
..._.._ �.... „mr _ Building Permit Application 'NE '!r—ilVr
Planning and Development Services NOV 0 �oj�
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 PERMITTING
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residentialst. Lucie County; FL
PERMIT APPLICATION FOR: I
Addres vwo P'�ePG� \"L • `3y� `�
Legal Description:
Pr►open ax s'"iU5 SO;I�—vd�v�\-1�11-6 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Y� Right Side: )O Left Side: i0
Name
Address:
City: mac _ Q'��C ut— State:se
Zip Code:7�� rl, Fax:
Phone No. S —kk
E-Mail: W'JUN\ 1 .C®N\
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Com'pany.;;
Address:
City: State:
Zip Code: Fax:
Phone No
E-Mail
State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER:. _ Not Applicable
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
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 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 addition, -
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
commencine work or recording; vourAotice of Commencement.
1�
Signature of- caner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF K.r
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this3D day of 0M 20 C�" • by
this day of . 20_ by
mac"���L, �4-�t�� i�•�,.1
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification %
Personally Known OR Produced Identification
Type of Identification
Type of Identification
/
Produced
Produced
Jasmk*A. Reid
tature� of No ry Public- S TARYPUBLIC
(Signature of Notary Public- State of FloridaSTATE
OF FLORIDAon
No.1
Commission No. (Seal)
Expires 7/27*020
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TU.RTLE,,;. ,
,.MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW.
REVIEW
.REVIEW
DATE
RECEIVED
t
DATE
COMPLETED
Rev. 8/2/17