HomeMy WebLinkAboutBuilding Permit Application ALL AppLICABLiE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEFIFED
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Building Permit Application
Planning ad Development
Building and Code RegulationDivision
!i Wrginid Avenue,Fort Pierce FL 34-982
Phone: 46 t • Commercial Resioential
PERMIT
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Code:City 5_�417_ 11Z M014L
Zip
PhoneNo.
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Fill in fee simple Title Holder on next page(if different Rr
from the
Owner listed
valueIf . $2500 or rRECORDED Notice of Commencement is required.
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DESIGNER ENGINEER: _ Not Applicable MORTGAGE COMPANY: �,� _ Not Applicable
Name: Name-
Address:
i
Address: Address;
City: State: City: i State:
Zip: Phone: Zip: Phone: !
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: Not Applicable
Name: Name: I
Address: Address:
City: City. l
Zip- Phone: Zip: Phone: 1
I
1 certify that no work or installation has commenced prior to the issuance of a permit. {
St.i ucie Coun17 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 thatmay restrict or prohibit such
structure.Please consult with your Nome 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 pians,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 Commence ant must be recorded ands posted on the jobsite
bef a the first inspection. if you "ntend to obtain financi consult wit lender or an attorney before
commencing w din r Notice of Commenc ent.
Jill l
01 i%A
Signat re of ssee Sig tore rORIDA e se Hold
STAT' OF F O D � � �,,,����� pp STA E QCOU U5.. — __ COUS�{3
The + r ging instr t as acknowledged before me The for aing instr ntrwas acknowledged before me
this J day of 20 loy tftis day of _,20,qty
J �'J
(Name rson ac owl dg g) (Name of pars acknowledging)
i
ignatwe of bita r P b)a State of Florida) nature of Vtiry public-State of Florida)
' OR P1FSdta Idk1as�aa#ion Personally Known � �,�d it is tlon
Personally K w -� —
Type of(dent ' i .ul� ry Public-State of FloridaType of Identificatlo re l@(
.. .�.
Mg Gc zr�-Expires Jul 22,2ol y ? .�.;� Y NE Ri)SSELl,
ssian ( � 8392 Commission No. _ ; Notary po�jftate of Florida
Commission o. I� Expires Jul 22,2017
��'r.P4��'���l Comm.Cammission FF 038382
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW 11REVIEW REVIEW
DATE
COMPLETE {
INITIALS