HomeMy WebLinkAboutBuilding Permit Application All • MUST BE.COMPLETEDFOR APPLICATION TO BE ACCEPTED
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Buildingit Z
Permit Application
Planning aDevelopment Services
Building . Code Regulation Division
00 Virginia Avenue,Fort Pierce FL 34982
• Residential
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orktobepertormed under this permit—check all that app y:
—Mechanical —GasTank Gas ' • Windows/Doors
Electric —Plumbing Sprinklers • ' ••
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
(70
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DESIGNER%ENGINEER: C ►, _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:
OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permit to do the work and installation as indicated.
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 inspectiori. 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 Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OFCOUNTY OF
The forgoing instrument was acknowledge fore me The forgoing instrument was acknowledged before me
thik' day of 20-IS by this'Z day of 20_KS by
(Name of person acknowledging) (Name of person acknowledging)
(Si ure 6f Notary Public-State o orida) (Signature of Notary Public- Florida)
Personally Known OR Prod uced.ldentification Per onally Known' OR Produ a Id
Type of Identification Producy of Identificatibn�l'o` NGRAM III
���,
Notary Pub
•State of Florida
Commission No. ;;: _ D ar Public-state of F rlda mission No. ec 20,2018
omm.Expires Dec 26 :r�Comm.E(�elp
{ L FF•�7a7 49 Co n;T ission# FF 177249
Commission# n 'yl w�,
�:r ��F;�` Bonded through National Notary Assn-
Assn.
REVIEWS FRONT; ING SUPERVI.S PLANS VEGETATION SEA TURTLE MANGROVE
COUNTEfY EVIEW REVIEW s EVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
-Re—v-.7/203.4