HomeMy WebLinkAboutBuilding Permit Application AU APPLICABLE INFO MUST BE COMPLETEDFOR r TO BE ACCEPTED
Date: i
tanning!and Development Services Building Permit Application
Building. .:•Regulation Division
23,00 il�lnla A venuE,Fort Pierce FL 349a2
CommercialPhone:1(772)462-1553 Fax:(772)462-1578
PERMIT APPLICATION FOR; ToSelect fromdropbox, click arrow - ♦ of
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FflI;n fee simple Title Holder an next page(if different
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if value of • -t—ruetion&4-2-5-0-0or more,a RECORDEDNotice of commencement
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name: i
Address: Address:
City: State: City: State:
Zip: Phone• Zip: Phone:
FEE SIMPLE TITLE HOLDER: r Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: city:
Zip: I Phone: Zip: Phone:
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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 hoiderto 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 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 tate 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,wells,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
commencing work or recording our Notice of Commencement.
Signature essee/Agent Signatu ntractor Li nse Holder
STATE OF FLORIDA. STATE OF FLORIDA -
COUNTY OF�� COUNTY OF—_= IJA ,.
The forgoing Instrurne t was acknowledged before me The forgoing instrument was acknowledged before me
this�day of% 20 I-U_by this_(.5,,,day of IJ ISL j 20 !L by
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(Name of person acknowl ging) (Name of person ackno ging)
(Signature of Notary t 6 teof Florida) Signature of Notary Pub tate of Florida)
Personally Known _ OR Produced Identification Personally Known f�OR Produced Identification
Type of;Identification Produced Type of Identification Produced
CommllSion No, �a„�, Sea Commission
A sF QE LORENL•RUF `.ea,Yt�+nvi
Notary Public-Statf of Florida t�` �'s GENA LORERZ Ref
nQ . Commission F 95 96 �, ._
Revi led Q7/15/2•� ''�i +�` My Comm.Expires Feb 7.2020 ' commission f FF 957961
My Comm.Expims Fob 7.2020
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGhOVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE i
COMPLETE:
INITIALS
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