HomeMy WebLinkAboutBuilding Permit ApplicationI
ALL APPLICABLE INF BE COMPLETED FOR APPLICATON TO BE ACCEPTED
Date: 0 Permit Number:
4_
Building PermjtApplication
Planning and Developmentservice5
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34992
Phone: (772)462-1553 Fax:(772)462-1578 Commercial Residential ✓
1 PERMIT APPLICATION FOR: To Select from drgp4DX, click arrow at the end of line
Address: ti3 o16— %� 191 e rc'e— FL
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Site Plan Name:
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E -Mail: 'Phone No. _11L—
Fill
11L—Fill in fee simple Title Holder on next page ( If different 'E -Mail" NMItSQt�{taui�t�u+Q(iniitiV
from the Owner listed above) State or County License: (CPL1Y�.b 411
If value of construction Is $2500 or more, a RECORDED Notice of Commencement is required.
Name:
Address:
City: State:
Zip: Phone:
\ FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
r-
COMPANY: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit
State:
_Not Applicable
St. Lucie Count makes no representation that is granting a permit will authorize the$ermit holder to build the subject structure
which is in con ict with any applicable Home Owners Association les, bylaws or an covenants that may restrict or prohibit such
structure. Please consult with your Home Owners Association andnrrEview 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 a posted on the jobsite
before the first inspection. If gyqu intend to obtain financing, consult w�I'th lende n attorney before
commenelne work or reearriiftk your Notice of Commencement. _ /'
STATE OF FLORIDA
COUNTYOF ie_
The for Ding instrum ntwaspcknowledged� re me
this 16 day of w 4/P_ . 20 A9 by
(Name of person acknowledging I
(Signatu otary Public..sfdte of Florida 1
77�i dd &RLI Z LAYA
Personally Known ��ffiQRr�Pmdu MI OOP on 12
Type of ldentifwtion rsgA ¢- EX RIEZi
EXPIRES VCtooer
Commission No. am(aee.asa FloRgagp°rvservice com
Revised 07/15/2014
ISTATE OF FLORIDA
COUNTYOF ST Lcir'i✓
Thefaf6oing instrume was` cknowledge fore me
this �jL day of
20_M by
OLcc �✓��atac
ame of person acknowledging I
(Signature of Notli:/azAduchlESWt1Dc1!fiN1AY4_
it da
((//
Personally Known yr.nuluQ
Type of Identification ge,�dW d-•'
Commission No. l O'�•^^' EXPIFt$$jjppOa�jttobar 1. 2018
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