HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL PPLICJ1/AB E INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �Icp A Permit Number: / �y
I� SCANNED
BY RECEIVED
St Lucie County
SEP 7 2018
Building Permit Application
-
Permitting Department
PI Inning and Development services St. Lucie county
Building and Code Regulation Division
23FO Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PE
MIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PAR'..
PQSEt IIVIPQIIEMENT LQCAT1t3N
Add "ess:
Lee I De:
r
Na
Ad
Name: �_
Company:
Zip Code:,3�t77U 'V Fax: City:'k nn' (,
Phone No. Zip Code: � T1 Fax:
I
E- ail: Phone
Fill in fee simple Title Holder on next page ( if different E-Mail:
fro t1i the Owner listed above) State or County License:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required
SUPPLEMENTAL"CONS,.TRU-,CTldN LIEN LAW 'INFOW Nil,'
D iSIGUPR/E9
GINIEER Not Applicable
I '.
MORTGAGE COMPANY: Not Applicable
Name:ROVI
1,1 SFJU&N
Name:
A 11
d4wss.
L/
Address:
o State: Kt
City: State:
Cit
zip".
Phone Lj'
Zip: Phone:
FEE
SIMPLE TITLE HOLDER: Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
11
Address:
Citi.
,�T
Ir
City:
i — Phone:
Zip: Phone:
zill
OW
ER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I cer
ify that no work or installation has commenced prior to the issuance of a permit.
St. LE
ie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
is in conflict ct with any applicable Home Owners Association bylaws covenants that restrict or such
whic
structure.
rules, or and may prohibit
Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In co
sideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
in acclor
ance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The fol
llowing 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
I
WARNING
TO OWNER: Your failure to Record a Notice of Commencement may result in your paying twice for
impi
ovements o your property. A Notice of Commencement must be recorded and posted on the jobsite
bef6're,
the first inspection. If you intend to obtain financing, consult with lender or an attorney before
comAticir
j&work or recording your Notice of Commencement.
I 6C-)
"4
ig.lature
f wnerl Lessee/contractor as Agent for Owner
Signature of Co tr ctor License Holder
STATE
STATE OF FLO I
MWiAJ
CO
COUNTY OF
Thee,
thi
oing instt
iN
day of rcnt l)A as acknowledged before me
201& by
The oinginstiWent as acknowledged before me
thi _day of 20k by
�'," of -R, a'
CZA1, 5:
-C
NaA of person making statement
Na4 of personmakingstatement
Personally
Known OR Produced Identification
Personally Known 1/OR Produced Identification
Typ
el of Identification
Type of Identification
Produced
Pro�luceclq
,
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A
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(Si
ature—of N'otar Pu
(Signature o
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BEV L. HADDAD P,
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WP B
Commission MYC �omml$SION # Q 0109363
EXPIRES. J ull -
EXPIRES: July 6, 2020
Bonded Thtu Notary Public Underwriters
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DATE
RECEIVED
D
iE
I
COMPLETED
Rev.
9'2/17