HomeMy WebLinkAboutPERMIT APPALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Dote: - Permit Number:
���~Uv�^�� ������� Application
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Planning and Development Services '
Building and Code Regulation Division
Z3D0Virginia Avenue, Fort Pierce 834982
Phone: (772)462'1SS] Fax: (772)462-lS78 CD0Om2rCiBlResidential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of lineTe-
Address:
Legal Description
Property Tax )D#:��No.
Site Plan Name- BlockNo-
ProjectNome:
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Setbacks Front Back: Right Side: Left Side:
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Total Sq. FtofConstruction: ������J Sq. Ftf First Floor:
Cost ofConstruction: S Utilities: L_]Sewer L=�Septic Building Height: |
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Address: Company:
E'K8mi|' Phone No.
Fill infee simple Title Holder onnext page (ifdifferent E -Mail: �
from the Owner listed above) |State urCounty License:
ifvalue cfconstruction is $250Vormore, aRECORDED Notice ofCommencement isrequired.
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DESIGNER/ENGINEER:
_ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
PLANS
Name:
Address:
Notary Pic State o d ,'
Address:
City:
State:
City: State:
Zip: Phone:
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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 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 yAu intend to obtain financing, consult with lender or an attorney before
commencing work or,.r i6g)vour Notice of Commencement. /
—Signature of t3 de/Agent
Signature
STATE OF tO .IDA STATE OF FLORIDA
C®lJNT ®FkZ
/E COUNTY OF
The forgoing instru t was ack owledged before me The forgoing instrument was 27,1ed d before me
this day of 20 by this day of 20 by
(Name of perdbh acknowledging)
(Signature of Notary Public- State of Florida )
Personally Known' OR Produced Identification
Type of Identification Produced
(Namye/of Okrson dcknowleogift )
re of Notary Public- State of Florida )
Personally Known( OR Produced Identification
Type of Identification Produced=_ - .
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Commission No. d p
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(Sea REISS SCHWAB
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Public - State of Florid
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No
205427
REVIEW
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Revised 07/15/2014
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