HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INF• MUST BE
COMPLETED FOR APPLICATION
D. - � Permit - •�
Building
, g • .. Application
Plunnin� and Development Services
Buildinj and Code Regulation Division
11 gjnla Avenve,Fort - 34992
Reside• -
46 462-1579 •
PERMIT APPLICATION FOR; To Select fromdropbox, click arrowrt •
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Address;
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Site Plan. Name: Block No. •
• Name,...)I ► •
Setback� Front �-J Back: KJ 10- Right Side:bA i�l— Left Side,
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Fll;'ectrl!� Plumbing 115prinklei-5 Generator Roof
Total Sq Ft of Construction:.L.0 5 Ft of First Floor:
Cost of a • + I 1 00utilities.11Building
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ESI ER/ENGINEER: Not Applicable MO TGAGE COIMI1PANY: Not(Applicable
ameNa e:
Address: Add ss:
City: State; City: : State:
Zip: --- Pts e: Zip: -
FEE SIMPLE TITLE HOLD : 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 Count makes no representation that Is granting a permit will authorize the permit holder to build•thie subject structure
which is iri conflict with any applicable Home Owners Association rules,bylaws or and covenants that may restrict or prohibit such
structures 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,performthe 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 t'he jobsite
before t'he first inspection, If you intend to obtain financing, consult with lender or an attorney*efore
commehcing work or recording our Notice of Commencement.
Si GC71' QS -- s
_Signature of Owner/Lessee%gent Signal a of oritractor/License Holder
STATE OF FLORIDA t STATE OF FLORIDA
COUNTY OFCOUNTYOF 10A0
Theforgoing instrument was acknowledged before me The forgoing Insfim
r ent was acknowledged before me
this I day of20 y this2Lg day of f61 20 by
(Name of.person acknowledgin j (Name of person acknowledging
i
r
(Signature of Notary Public- tate of Florida). (Signature of Nota ryTublic,.State of Florida)
Personali;'y Known Personally Known
Type of ldentificati d Type of identification P IIID HELLS 1r� MAS
M!t.Ki`:LIM
MY COMMI4SICIN#F10D795 "c i.4 MY COMMISSION#FF1007A5
Commission No. F r t , pines 2 ,2o1ia Commission No.
- �•-."� . eXPIRAroh 2:3,201 ti.
401)398.0153 Floridnt4oiaryservioaxom (d0 3ii$0153 Fiorfcleygta 8ervioexvm
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
GATE
COMPLEIE
INITIALS'