HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll
LICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
,Sa,a' k 44 6 k `7 Permit Number:.
P16nning and Development Services
13gilding and Code Regulation Division
2J 1 00 Virginia Avenue, Fort Pierce FL 34982
Phone: one: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Address
h'UANN U RECEIVED
ES Y
Building Permit ApplicationSEP 0' 1* 20.17
PERMITTING
St. Lucie Coun
ty, F
Commercial Residential
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Site Plan Name: Block No.
Project Name: r
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ddress:, .1° 6' '15 ISI
State:
Zip Code: ;-0— Fax:
Phone No. 4&.P-D 2-0.-2—
E Mail:
Fill in fee simple Title Holder on next page if different
from the Owner listed above)
CdmpanyM)
Address: C -rr a P(q.
City: State:
Zip Code: Fax: 0 2,_7
Phone No 7
E-Mail
State or County License CCC 13,-3 6
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address: x
City: State.'
Zip: Phone
FEE SIMPLE'TITLE.'HOLDER:
Name:
Address:
City:
Zip: Phone:_
Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:'
Z-ity: 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. .
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.
P S - MKOM IQJ
Signa re of Owner/ Les ee/Contractor as Agent for Owner
Sign ture of Contractor/License Holder
STATE OF FLORID
STATE OF FLORIDA
COUNTY OF
COUNTY OF
The f rgoing instru eat w �s acknowledg efore me
The f rgoing instru e w acknowledg d fore me
this day of 20. by
v�
this day of f2O,by
(Name of person acknow edging)
(Name of person acknowledging)
(Signature of Notary Public- State of Florida)
(Signature of Notary Public- State of Florida) 1
✓
Personally Known OR P Identification
Personally Known lion
Type of Identification ,,,�'F��,,
o '��""',n,, KARE.N S. NIELS
:. R� eo
f Identification `+ `^'= km REN S. NOEL
Produced _• �s Commission # FF 11
1SEN
3r�d ced �,��,o�.�. Co�ssion FF1156
'� mmission
My Commission Exp
Commission No. I ''������"` eal .tune 12, 2018
res ,�"
E)rPires
Com ission No. 12 2018 es
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 7/2014