HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONI
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All APPLICABLE INFO MUST BE COMPLI--' 'll FOR APPLICATION TO BE ACCEPTED a
Date: �A, W Permit Number:
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Bui 4�,f@r1 , it Application
RECEIVED
JUN 1 1 201
ST. Lade Coi4nt Permitdn
Commercial Residential
PROPOSED INPROV;E;MENT LQCATION.a , . .
Address:
Legal Description: L0 1—
Lot No.
Block No.
OWNER/LESSEE.
CONTRACTOR
Name �i �1-M� 1 `l�l
Name:
Address: 1�-
Company:_ � 1 'f UN; 4ti. C Lt snl:
' tA Ulyl l/VV
City: �� �,- " State:
Address 0 S 0
Zip Code: Fax:
City:
Phone N6._77 Z`2-'-c(0jyL/
Zip Code: 3 4, Ct c'l J Fax:
E-Mail: L_V &4 7 N'- P, A-O L-, CO AA
Phone No `1 % Z 1(o (374 4
E-Mail el a (S
63 ti,
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
State or Co ty "License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address: i
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
MORTGAGE COMPANY: = Not Applicable
Name:
Address:
,-City: State: _
Zip: Phone:
DING COMPANY: Not Applicable
Name: Name:_
Address: `�. Address:
City: i` 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
commencing work or recording your Notice of Commencement. J,
Signa ure of Owner/ ess a/Contractor as Agent for Owner
Sign re of Contractor/License Holder
STATE OF FLORIDA
STATE OF 'FLORIDA
COUNTYOF 1L' l _
� �
COUNTY OF � • L1laff—
The forgoing instr inent was acknowledged before me
this day 20 by
The forgoing instrument was acknowledge efore me
this day 20 by
of
of :J �j INJE ,
NX ;1 �1 �m1�(z
�� i
��Is(1��
(Name of person acknowledging)
(Name of person acknowledging) .
�
44 c9----�
(Signature of Notary Public- State df Florida)
(Signature of Notary Public- State of Florida )
Personally Known OR Produced Identification V/
Personally Known OR Produced Identification
Type of Identifi at' n
Type of Identific n
Produ ,
Produced
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��4'PY P,,/� KAREPI S. NIELSE�L
d,°n V..State of Florida•Notary P ®��
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`�y911�Y P,,e C
Commission No. 3N
4'ssre eAo KJta"16LSEComm
#! CG 20�484
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DATE
COMPLETED
Rev. 7/2014