HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONv
ALL APPLICABLE I FO UST E COMPLETE,Q�l �af;.pL,CaATl0�0 BE ACCEPTED
Date: Permit Number: ( o z 7
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential_
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PERMIT APPLICATION FOR: To Select
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Legal Description:
Property Tax ID #: 44cQ(y— G (1�5"" Lot No.
Site Plan Name: H(ar kDOJ��i q�� Block No.
Project Name: C: -2-e.t1U=KQ
Setbacks Front Back: Right Side: Left Side:
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DESIGNER ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name; Name:
Address: I Address:
City: State:! City: State:
Zip: Phone Zip: Phone:
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FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
Address: Address: '
City: - City:
Zip: Phone: I Zip: Phone:
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OWNER/ CONTRACTOR AFFIDVIT: Application �s 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.
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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 rec_nrding vnur NntirP Af Cnmmanramant
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Signtit ure of Owner/ Lessee/Contractor as Agent for!Owner
Sig re Contractor/License Holder
STATE OF FLORID 4 , , (�
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The fo,�8�o__��ng instr ent wa acknowledge efore me
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Name of person making statement
Name of rson making statement
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Personally Known OR Produced Identification
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