HomeMy WebLinkAboutBuilding Permit Application • 1 1 C� 11 11
APPLICABLEALL • MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
1. • • /
Building Permit Application
Planning and Development Services DEC 2 1 I.
15
Building and Code Regulation Division
// Virginia Avenue,Fort4.
Phone: • ••2-1578 Commercial Residential
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if value of construction is$2500 or more,a RECORDED Notice of Cbrnme ncernent is required.
12/29/2015 12:02 FAX IM 002/003
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 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 it, 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 recordITT-9 your Notice of Commencementf„
'�' / ,, no ��lY/' '• \ Pd'. t i'+'q /•fin.
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S ghatd're of Owner/Agent/Lessee signature of C6rr6actor(l icense Holder
STATE OF FLORIDA L STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing instrument as acknowledged before me The forgoing instrumInt was acknowledged before me
this day of, � c°C... 20 by this�day of ..�`— 20_by
J 11:;•l yv � �'.r p,. j � 4`.,��.: f.�:..J'^' JI ,! ' 1' tai' • s .. ..a
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(Name of person acknowledging) ame of person acknowledging)
(Sign tip a o'f Notary Public�S, to of Florida) (Signature of Notary-Public-State..o0lorida)
,—
Personally Known OR Produced Identification Personally Known OR Produced identification
Type of Identification Type of Identification Produced
LESLI D ZELAYA Y
..•O1T....8,�••y= ;1�AY PUO• l PLAYA
Commission No. �' Commission No.
LESL
MY CO��t SION#FF165172
EXPIRES October 1,2018 s;y. •as
MY COMMISSION #FF165172
14071 398.0153 FlorldallolmService.com •'"•9'..!`•
Revised 07/15/2014 (407)398.6153 rioridallotaryServlce.com
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