HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO OF ACCEPTED
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PlanningBuilding Permit Application
and Development
Srullding and Code REgulation Division
2300VirginiaAvenue,Fort
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BlockLot No.
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Zip Code: Fax;
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Phone 1 17 /
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Fill in fee simpti!Title Holder on next page(if different
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DESIGN ER-JENGINCER! Not Applicable MORTGAGE COMPANY: __LX4 Applicable
Name: Name:
Address: Address:
City: State:_ City, State:
Zip: Phone: Zip:
FEE SIMPLE TITLE HOLDER., Not Applicable BONDING COMPANY: _tAcif-Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip; Phone:
I certify that no work cir'Installation has commenced prior to the issuance of a permit.
5tLucle Coun ermit holderto build the subject structure
make authorize makes representation that is granting apermit will autho zethe
whichis'Imco", ictwit al �plfcable Home Owfierr;.Astociatl4bn rules,bylaws or anScovenants that may.restrict or prohibit such
structure.Please consult W A your Home Owners Association and review your deed for any restrictions which may apply.
ln,corisideratlori 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 Cod4s and St.Lucie County Amendments.
The following builclinI;permit applications are exempt from undergoing a full concurrency review.room additions,
accessory structures,swimmingpools,fences,walls,signs,screen rooms and accessory uses to another non-residentlil use
WARN,ING 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
cormin6ricing Work or recording your Notice of Commencement.
s
/Agerit�
r0j-f,0b, ntr,otorlU
. ,A, tenseHolder e!s"
STATE OF FLOR STATE OF FLOR
COUNTY OF COUNTY OF
'rhe f%ooinginstru ent asacknowledge oAafore rne The f oing instrpmqnt�was acknowledw4 before me
thlsj_!�2clayof 20 L�v this day o 20 by
W.
(Namef erson acknowledging) (Name of per on acknowledging)
(Signature of N tarVPubl- -State of Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification Personally Known V _ OR Produced ldentlficatfon
d— — 40, Type of Identl
Type of Identificaltin Eau&
CRO U Commission N'
Commission No.
0
Florida'
:'.S Notary Public,State-dI flofift'.: zary 06bilic,State at
is _W My comm.lixPirR;.JuI*,�.,.2iYf` My Camra.Expires'jul 3t,2815
Gammi5sion EE 117478
Revised 07/1
REViEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
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