HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED • ' APPLICATION TO BE ACCEPTED
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Building Permit Application
N L D Fi C D rt —
PlannIng and I
Building ♦ ♦ Codie Regulation
Phone:2300 Virginia Avenue,Fort Plerce FL 34982
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Zip Code: Fax:
Phone No..—Tf. • * ,
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Fill in fee simple Title Holder on next
.: different
from the
Owner listed above • • _�
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S=Ac%
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: 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 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 fallowing 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 Commence ent must be recorded and posted on the jobsite
bef a the first inspection, if you'ntend to obtain financi ,consult wit fender or an a torney before
tom, encin w din r Notice of Comment . ent.
Signat a of ee Sig tore o Co tra ice se Hold
STAT OFF 0 STA E C►F ORIDA
C 0 U 0 � �`�- COU OF
The f oing ins u ent sac nowledged before me forgoing acknowledged before me
this day of MW20 V_by this f dayof
ent was 20� iY
i t
(Nam f pe s acknowledging {Name of peQ91"acknowledging}
lgnature of N ary Public-State of Florida) nature of tary Public-State,of Florida)
� a
Personals Known �oduc
Personally Known ;; Y,educed,i�>A�t'�14�ffAsr-ti_ _ y • • �' f(f3' l=
Type of identification o c :� Nar�ry Paltlir.,•-.�Latesl..Flarlda Type of identification E0 e
3N' �q4y My Comm,Expires Jul 22,2017 '+ *'+ My corn ExR res Jul 22,2017
Commission No. cooei�Qlon#FF 038392 Commission No. Comt&M� 11#FF 038392
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS