HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONJ
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: I Permit Number: 9 �� ! • ���
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Building Permit Application APR 091201
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
PERMIT APPLICATION FOR:
Address:
Legal Description:
Property Tax ID #: «L�
Site Plan Name:
Project Name:
Setbacks Front
Back:
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Right Side: Left Side;
Permitting Department
St, Lucie County
Residential
Lot No. ?)
Block No. ( c-N2
Name RY/ &Q Ld, JQ u h Name:
Address: UO(I -2-- Compa`ry:
City: - L Q jrCC State: Oi� Address:
Zip Code:34--T I Fax: City: State:
Phone No. ii Zip Code: Fax:
E-Mail: Phone No
Fill in fee simple Title Holder on next page ( if different E-Mail
from the Owner listed above) J State or County License
I
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
N.R
PPLMENTAtCpt1VST�CTIG1N LfiII liV�D�R1lIT+}y777
DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY: Not Applicable
Name: ' '
_
Name:
Address: I
Address:
City: State:
City: State:
Zip: Phone I
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Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
BONDING COMPANY: Not Applicable
NaMle: =
Name:
Address: I
Address:
City: I
City:
Zip: Phone:
Zip: Phone: I
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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 colmmenced prior to the issuance of a permit.
St. Lucie County makes no representation t1hat 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 such
prohibit
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
commencing work or recording our; Notice of Commencement.
Signature of Owner/ Lessee/Contractor as
Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF
The forgoing instrument was acknowledg Id
before me
I
The forgoing instrument was acknowledged before me
this a dayof , 20 ($
by
this I day of 20_ by
(Name of person acknowledging)
(Name of person acknowledging)
(Signature of Notary Public- S to of Floridia)
(Signature of Notary Public- State of Florida )
n
Personally Known OR Produced I
entificatio
Personally Known OR Produced Identification
Type of Identification
Typelof Identification
Produced A
HAHNA INGR_ '
Produced
Notary P
Co
Commission No. "' `p,E M m
(ile_a.;)ires
blic -
I State of Floriday
Commission No. (Seal)
%q of FlOa•� tom
"����",� Bonded
Dec 20.2018
IF 177249
V
th o�$sibn
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Notary
REVIEWS
FRONT
ZONING
SOE70MI
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
I�
DATE
COMPLETED
ev. 7/2014