HomeMy WebLinkAboutBuilding Permit Application •MPLETED FOR APPUCATION TO BE ACCEPTED •
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Building PermitApplication
Planning and Development
Building and Code Regulation
II Virginia Avenue,Fort Pierce FL 34982
Phone: 462-1553 Fax:(77-2)462-1578 Commercial Residential V'
PERMIT A' • O' �•
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o-i- �l Work tQ be berformed under this permit—check all nshutters Piping
HVAC Ga's Tank Gas
Total Sq. Ft of Construction; Sq.Ft.of First Floor:
Cost of Construction:
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Name r6L Name: bo r)
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Phonezip C6de: Fax: ity: State,
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(04-79b
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Fill in fee simple Title Holder on next page J if different -Mail::pr * 1 1 ry / / N)rn
from the Owner listed above) or •
If value of construction Is DO or more, .RD . of Commencementrequired.
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OEM @11'21: 5
DESIGNER ENGINEER: _Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip:. -.Phone:
FEE SIMPLE TITLEHOLDER: _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 holderto 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 our Notice of Commencement.
LJ A L-�== —s
_.Signature of Owner/Lessee/Agent Signature of Contracto icense Holder
STATE OF FLO�If��� STATE OF FLO 1
COUNTY OF f11L1[JI. COUNTY OF V)Uk+t Y ---0
The for g instrument was acknowledge efore me The forgo ng instrument was acknowledg d efore me
this day of 20by this 71LRay of 20 by
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N6&�-n
{Nameo�f person acknowledging) (Name of per54n acknowledging)
bwA-hl
Dmvl".
(Signat r of Notary Public-State of Florida} (Signature Nota lry Publ c-State of Florida)
Personally Krrown V/ OR Produced Id t o Personally Known V OR Produced Identification
di ie'A%A
Type of Idents p y( ��[� Type of Identification
DIYIP1�44• CRYSTAL 2UFMEP •. NIIIIf„+
� ���41,Av N +.; RYSTALD(JU111D
Commission N 3= • a} pay publ'iC($;at •af Florida Commission No. Notsr J�,
}� My Gamm-1:xpiros JupSt, "' my comm.Expi-Cmmirn 1=E 117478GrMss! JE
Revised 07/
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
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