HomeMy WebLinkAboutBuilding Permit Application a J . 201 l
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Address:
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Legal Description:
BlockProperty Tax ID Lot No.
Site Plan Name:
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Project
Setbacks Front Back: Right Side: Left Side:
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Total SqFt of Construction: Sq. Ft.of First Floor:
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Cost of Construction: ight,
Utilities. Sewer _Septic Building Hei
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Phone ■ i6d . Code
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Fill in fee simple Titie Holderon page
from the owner listed above) State or County License: C-A C 0�5 R IQ
If value of construction is2Affor more,a RECORDED Notice of Commencement is required,
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DESIGNER/ ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Narhe: -- --
Address: Address:
City: State: City: State:
Zip: Phone: Zip: _ i'horie:
FEE.SIMPLE TITLE HOLDER. Not Applicable BONDING COMPANY". Not Applicable
Name:. Name:
Address: Address:
City: City:
Zip: _ Phone: zip: Phone:,,',
OWNER/CONTRACTOR AFFI1DVIT'.Application is hereby made to obtain a permit to do the work and instailatibn as indicated,
i cera fy 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 errnit holder to build the subject structure t
which is in conflict with any applicable Home owners Association rules,bylaws or andpeovenants 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,l do hereby agree that i will,in all respects,perform the work
in accordance with the approved plans,the Florida Buildimg Codes and St,Lucie County Amendment5.
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 failike to Record a Notice of Commencement may result In your paying trice for
impro'rements to your property.A Notice of Commencement finest 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/Ag t /Lessee Signature of Contra r/Liicense Holder
STATE OF E1.d31 IDA STATE OF FLORIDA �y
COUNTY OFi COUNTY��
The forgoing instrument was acknowledged before me The for oing instrument VYas acknowledged before me
this day of 2015-by this day of 20 by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of!votary Public-State Florida) (Signature of Notary c-State lorida)
Personally Known OR Produced identification Personally Known OR Produced identification
Type of Identification Produced Type of identification Produced
MYGOA 'S 14NfEE858 anAttp g
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Commission nio, � � � I SAES Api��y 057 Commission tVo. � ��'�� ;(' fS,P� WAR
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REViEWS FRONT ZONING SUPERViSOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
.DATE
RECEIVED
DATE
COMPLETED
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