HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION'TO BE ACCEPTED
Perm-It Number,
Building Permit Application
Planning r ► Development
Sudding and Code Regulation Division
2300 ♦ r Avenue, ►
Phone:(772)462-1S53 Fax:(772)462-1578 Commercial Residential
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Cost of Construction:$ Utilities.
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Name
ame 1,
Address: �any.
Zip Code: \trlsA Fax: City: \ec� L State:
Zip Cod Fax: 2L�:LWI
EmMaik Phone dVISO
Fill In fee simple Title Holder on nw page(if different E-M I t
Stat:or 8 nty Licefrom the Owner listed above) u rise* -7'-JL'r
it value of construction is
11 or more,- RECORDED Notice . •.
E Rul'I
���{{,!,!,,.W.+�
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: Not Applicable
Name! Name:
Address:_.__. _
__ ,,,•,,, Address: •
City: State: City:
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 represent tion that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Associatlon 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 fell 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 CommenceJent must be recorded and posted on the jobsite
bef a the first inspection.if you "ntend to obtain finaricconsult wit lender or an attorney before
cam encin w din r Notice of Commenent.
5ignat, a of ssee sig ture o Co tra ice se Hold
STAT OFF OR STA E OF O
COU O 1 COU OF Cj
The for oing instrumen wa acknowledged b fore me The forgoing Instrumen was acknowledged before me
-this day of V 20 1 by this Nday of 20
1
JERAIYt RU
KI t r 1hli e F
1
(Name per' i; tb "�ipr$�m .Expires ue erson cknowledging)
m won# FF 0385
gnature a Notary Public-Sta f Florida) Signature of ;€ t @I Plp�iAla rare o
o'F YCComrn•Expires Jul Florila
Personally Known OR Prodo mmp i�
uced Identification Personally Kno OR PrIN
Type of Identification Produced _ Type of Identification Pro u e
Commission No.MCI
(seal) Commission No. (Seal)
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PIANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
GATE
COMPLETE
INITIALS