HomeMy WebLinkAboutBuilding Permit Application 1 � 1 1 � !•� 1 1 1 1
ALLAPPLICABLE • MUST BE COMPLETED •• APPLICATf.PN TO BE ACCEPTED
Date: Permit Number:
Building • Application
Planning• • I• -
Building and Code Regulation Division
// Virginia Avenue,Fort
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04/27/2015 10:37 FAX 2002/003
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DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: !Name:
Address: iAddress:
City:- State: ;City: State:
Zip: Phone: 'Zip: Phone:
FEE SIMPLE TITLE HOLDER: �Not Applicable :BONDING COMPANY: ^Not Applicable
Name: ;Name:
Address: Address:
City: 'City:
Zip: Phone: Zip: Phone:
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 property. A Notice of Comrnencetnent must be recleo
and posted on the jobsite
before th /firs ins eetion. If you intend to obtain financing, consult with or an attorney before
comme t w r � . cordin our Notice of Commencement.
Si ure of Owner/ nt/Lessee Signa, re ofto-nt ct r/License Holder
STATE OF FLORI STATE OF FLORIDA
COUNTY OF Lc/ciJ COUNTY OF
The for Ding instrument was acknowledvari before me The forgoing instrument was acknowledged before me
this for
of— o�01.S-by this day of_
(Name of person acknowledging) ({Jame of person acknowledging)
Pu " - da
) (Signatu Notary Public-S e Flo
(Sign uof Notary Ptate lori
a)
Personally Known Personally Known�_OR-,Pr qc P01-11SWA
Type of Identificatio i P?�i' s� Type of Identification Produced
•' MY COM ��ON#FF1651 72 EXPIRES,9ct bet 1,2018
Commission No. ;w• Commission No. ea
F XPIRE October 1,2018
c•�.:153 Florida otary ervice,com
407 388.0153 FlorldaNataryservice.com
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR .PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS