HomeMy WebLinkAboutBuilding Permit Application � � 1
COMPLETEDALL APPLICABLE INFO MUST BE •R APPLICATION TO BE ACCEPTFD
Date: aox Permit Number, C)q
RECEIVEED SEP 2.92015
Building
Permit Application
Planning• • Development
Ouilding and Code Regulation Division
01 Virginia Avenue,FortPierce
Phone: 4. ' .2-1578 Commercial _ Residential
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Property 1
Site Plan Name, Block No.
Project Name:
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Name—
Address: 9& 9z
ity: state:
Zip
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Code- !Phone No. !I 1�
i 36
Fi
Fill in fee simple Title Holder on next page(if different
from the Owner listed .. or Countyit .!
if value of construction Is i►or more,a RECORDED Notice
SEP-28-2015 17:07 P.03
SUPPLEMENTAL CONSTRUCTI N UEN.LA1-"INFORMUTATION:
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name: '
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: of 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.
$t.Lucie Counter makes no representation that is granting a permit will authorize thepermit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules,bylaws or and covenants that may restrict or prohibit such
structure.Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit,I do hereby agree that I will,in all respects,perform the work
in accordance with the approved plans,the Florida Building Codes and St.Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review:room additions,
accessory structures,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use
WARNING TO OWNER:Your failure to Record a Notice of Commencement may result in your paying twice for
improvements to your property.A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing,consult with lender or an attorney before
commencing work or recording our Notice of Commencement.
5
_signature of Owner essee/Agent Signa ure of Contra or/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of 20 _by this_day of 20 by
(Name on ledging) f per nowledging}
i +
(Signature of Notary e o ori a) (Signature of Notary Public-State of Florida)
Personally Known /� OR Produced Identif atian Personally Known OR Produced 1 ntificati n
Type of Identification Produced_ Type of Identification Produced
Commission No. r- (SefIdOOWN{NG Commission No. ENDOWNINp
MY co."N'$SION FF D36578 �yf ::x.'
036
JIAIYEXAIRES:July 21,2017 h4Y CO Y1MI55i0N 21F2017 6
_ 90nd hrti Nonry(uHit
UndcrWROM
Revised 07/15/2014 —� - '
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS