HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE-INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 1
Date: Permit Number:
RECEIVED MAY 01
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To,Select from.dropbox, click here M
PROPOSED IN,I?
14 fee,
SUPPLEMENTAL CONSTRUCTION LIEN LAW.INF0RMATI0N,:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name.:
Address: Address:
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:
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 wop ecording your Notice of Commencement.
X.
Signature of Owner$Agent /Lessee Signatufe of Contractor/License Holder
STATE OF FLORIDASTATE OF FLORID,
COUNTY OF /_4107 /,F,4ell 6011 ,, COUNTY OF /�%i lf�&J C efl-rz
The forgoing instrument was acknowled ed before me The forgoing instrument was acknowledged before me
this % day of �" 4 20 f!5 by this L day of Adds' 20_Z]by
(Name of person acknowledging) (Name of person acknowledging)
(Sighat re f'No arSf c-State of Florida (Signature'of Not' ry'Public-State of Florida)
Personally Known OR Produced Identification Pers6r}�lly� own *t OR Produced Identification
Type of Identification Produced Type of Identification Produced
JOHN EDWA
Commission No. �aP�a�, RaIFFORD. .
JOHI�EdWARD GIFFOR®, Commission N .,a ""'`�_
MY COMMISSION#FF077427
+� }•) MY COMMISSION#FF077427 �..• %o��
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Revised 07/15/201 (407)'398.0153 FloridallotaryService,com
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