HomeMy WebLinkAboutBuilding Permit Application -All APP'LICABLE INFO MUST BE COMPLETEDFOR APPLICATION TO BE ACCEPTED
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Planning • • Development
Building r r Code RegulationDivision St. LucieCounty,
// Virginia Avenue,Fortt ':
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Site Plan Name: Block No.
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Additional work to be performed under this permit—check all that apply:
—Mechanical GasTank Gas
• • Windows/Doors
Electric Plumbing Sprinklers • ' ••
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
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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:
OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permit to do the work and installation as indicated.
I.certify.that no work.or installation has commenced prior to the issuance of a permit.
St. Lucie Countyy.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 inspection. If you intend to obtain financing, consult with lender or an attorney before
comAWncing work or re-cQrding your Notice of Commencement.
igtureQfs ui�q n+ L� Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
_j
COUNTY OF COUNTY OF
The forgoing instrume t was acknowledged before me The forgoing instrument was acknowledged before me
this day of e204 by this day of j20 by
I
(Name of person acknowled ' g ` (Name of person acknowledging)
(Signature of Nota Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced =N1E:tS1:N
f Identification Produced
KARoCommission No. a�ommission No. (Seal)
_ 1y CJ
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.