HomeMy WebLinkAboutBuiding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION To 13E ACCEPTED
Date:
Permit Number,
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Planning and DeveloPment Services Building Permit Application
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone. (772) 462-1553 Fax: (772) 462-1578 Commercial
To Select from dropbox, click arrow at tf�e end of line
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Site Plan Name: Li Lot No
Project Name: Block No.
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Name J� 1 11 - "I'll, K, ..
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Address:'11,2 _17 -Y ' —,—
City: 1) C'kr�''
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Zip code: 6L�Ovg - Fax: State: FL_
Phone No. r7') 14 —
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name:
Company:
Address: 154 -
City: P --3 L
Zip Code: StaterFax:222---li iiiiiiiii
Phone No, '-7-7 A ....... .......
E -Mail:
State or County License:
If value of construction—
is or more, a RECORDED Notice Of Commencement is required.
DESIGNER/E=NGINEER:
Name:
Address:
City:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:
— Not Applicable
State:
Not Applicable
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: _, Phone:
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
Not Applicable
tate:
—Not Applicable
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 you intend to obtain financing, consult with lender or an attorney before
commencin r recordi Llr Notice of Commencement--------
Signature
ommencement.,—
Signature of Owner/ Lessee/Agent
STATE OF FLORI A
COUNTY OF_ r- • I �._
The forgoing instr ment w s acknowledged before me
this day of K1 20( L(�_by
{Name of person acknowledging }
r~
_(-fgglature of Notary PJblic- State of Florida }
Personally Known - .G!? p ed Identification
y.,.... �E
UNDA MAI
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O Yr715$ioN)�59MMIS-SiON #FF195526 (52aI)
�: EXPfIIG�y 21�IS
Revised 07/ f 512014
REVIEWS [FRONT
COUNTER
DATE
COMPLETE
I INITIALS
Signature of ontractor/License Holder
STATE OF FLORIDA
COUNTY OF -r
The forgoing instrument was acknowledged before me
this i 9-A day of 20 ( . by
� I
(Name or person acknowledging }
1 \ !i n w
rea,?Notary Public- State of Florida }
P rgitbt�Crr fdentifi atio7
tT ca N e
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MY COMM#SS10N # -'----
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(407 398-0153 (seal;}
I FloridaNfotary5ervlc W_
ZONING SUPERVISOR �PLAN'.
REVIEW REVIEW REVIEV
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VEGETATION
REVIEW
SEA TURTLE
REVIEW
GROVE
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