HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION To BE ACCEPTED
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Building Permit Application
Planning • r Development 1 • 12016
Building and Code RegulationDivision
11 Virginia Avenue,Fort Pierce FL 34982
Phone: (772) • J• Commercial Residential• .
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Fill in fee simple Title Holder on next page If different
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fr6m the Owner listed above) - . • �'��� Y
DESIGNER/ENGINEER: _ _Not Applicable7Address:
E COMPANY: _Not Applicable
Name:
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 p&mit,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
imp ovements to your property.A Notice of Commence ent must be recorded and posted on the jobsite
be# a the first inspection. If you ntend to obtain financi ,consult wit lender or an attorney before
com encin w din r Notice of Commenc ent.
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Signat re of ee Sig ture o Co tra ice se Hold
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STAT OF F O DIA. COU E OFOFpR(STA C��� l t�
COU O +
The forgoing instr ment was acknowledged before me The forgoing instr►f{�e t was acknowledged before me
this Z:(day of 20 1{_by this r day of 20_L4r
&I"QnhLZU,
Name of pjrson acknowle ing) (Name of p rs n acknowledging,
ignature of otary Public State of Fiorlda) nature of Notah Public-State of Florida)
Personally Kno „ OR Pro uce enL ication Personally Known +�Q�Produced Identi ication
Type of identifi t! dyed JEftALYNNE RUSSELL yp 6'- JERALYNNE RUSSELL
T e of Identificat' rd
o ary Public- tate of Florida = ' * _ Notary Funlic a B of or da
^� m.Expoul 22,2Ui7 omm. Jul 22,2017
Commission No. , ��rL misslo 1038392 Commission No. ���+�������� ` miS8ibn I 0,38382
Revised 07/1512014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS