HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICAiriON TO :
Date: Permit UCE -D JAN 13 2016
• . •
Buil
f •ermftApplication
Planning and Development
Building and Code RegulationDivision
/I Virginia Avenue,Fort
Phone.(772) /•2-1553 Fax:(772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, cliCk arrow at the end of line'
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DESIGNER/EN OEM- —Not Applicable MORTIS E COMPANY: Not Applicable
Name: Name: —
Address: Address:'
—
City: State: City: State:
Zip: Phone: zip: Phone: I
FEE SIMPLE TITLE HOLDER: �Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
Address: ___ Address,
City: City:
Zip: Phone: Zip: Phone: ;
1 certify that no work or installation has commenced prior to the issuance of a permit.
St.Lucle County makes no representation that is granting a permit will authorize the ermit holder to build the subject structure
which Is in conflict with an applicable Home Owners Association rules,bylaws or an9covenants that may restrict or prohibit such
structure.Please consult with your Nome owners Association and review your deed for any restrictions which)I may apply.
In consideration of the granting of this requested permit,I do hereby agree that I will,in all respects,performlthe work
In accordance with the approved plans,the Florida Building Codes and St.Lucie County Amendments. I
The following building permit applications are exempt from undergoing a full concurrency review-room additions,
accessory structures,swir.»ming 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 youi"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
commencin work orrecorclLn9your Notice of Commencement.
Signature of owner/Agee Lessee Signature of Contractor/License Polder
'STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The g Instr twos act owledge before me Tlie. instr ' cin wledge' efore me
this Md y of 20, I y this 20 y
_ 1
(Name of peP n ackno ledgi g) ' (Name o person c now a ging}
/w// ''
(Signature of Notary Pub c-State of { tda) (Signature of Notary Public-Stateof ori a)
Personally Known'. OR Produced identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission Commission Nop'�f 1eal)
. ,CRYSTAL i87463
5 JutiP 29,?A18 RY
Revised Q i4 >r IRME *WP153
MY COMMISSION#EE197463
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REVIEWS FRONT ZONING SUPERVISOR PIANS VEGETATI
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
ENITIALS
E0/E0 39dd ?IIb HUb39 N3SN3f GELSESEZLL 0117:00 1Z0Z/Z0/0Z