HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED,FOR APPLICATION TO :
Permit Number ' 9 • ,
Date: As
Building Permit Application
Planning and Development
Building and Code RegulationDivision
/1 Virginia Avenue,Fort ••
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
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Plumbing •rinklers' Generator '••
Total Sq. Ftbf Construction: �$q. Ft.of lFirst Floor:
Cost of • • ! Utilitids: Sewer Septic Building
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Phone No
Fill in fee simple Title Holder . r-
from the
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If value of construction is 00 or more,a RECORDED
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address: w
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address: w
City: 1 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 work or recording our Notice of Commencement.
Signature of Owner/Agent/Lessee/Contractor Signature of Contractor/License Holder ;::-:.-�"
STATE OF FLORID STATE OF FLORI
COUNTY OF COUNTY OF
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The forgoing instrLAent was acknowledged before � ; � The for oing instru ent was acknowledged bef r
this_LV day of 20_ by m this day of 20_rb 2 mm
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(Name of person acknowledging) s (Name of person acknowledging) a;N E�
(Signature ofary Pub it-State of Florida) (Signature of N ublic-Stat of Florida)
PersonallyKnown OR Produced Identification Personally Known L----OR Produced Identification
Y .
Type of Identification Type of Identification
Produced Produced
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.