HomeMy WebLinkAboutBuilding Permit Application ALLA- PPLICABLE INFOBF-COMPLETED •R APPLICATION T• : ACCEPTED
• • IS
COUNTY
• • Permit -
Planning I / Development
Building and Code RegulationDivision
2300 Virginia Avenue, Fort
Phone: • a • Commercial
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BlockAddress:_7442-01 1111
Site Plan Name: •
ProjectName: Sax)& ,o o1 •
Setbacks • •- Side:
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.i._ .S'Additional work to be-p-effill under this permit—check all that apply:
■ a ■ Gas Tank ■GasPiping ■ Shutters Q<Vindows/Doors
Electric Plumbing OSprinklers F]Ge inerator Roof
Total • of • • SFt • ••
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Cost of Constructill ILI
Sewer OSeptic Building Height:
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7DESIGNERANGINEER:
Not Applicable. MORTGAGE 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 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
commencing work or recording our Notice of Commencement.
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_Signature of Owner Lessee/Agent Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLOR DA�S
COUNTY OF Z COUNTY OF� Q �
TZ r oing in r ent was acknowledge efore me T orgoing instrument was acknowled ed before me
day o 20 th�day of 20�by
(Name of person acknowledging) (Name of"person acknowledging)
i
-L,( A A nA.- _N
ignature of Notary Public-State o lorida ) Ignature of Notary Publ' -State of Florida )
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Prrood�uccedc/ Type of Identification Produced
tiCQ
Commission No.GkE�
p�EUSAAR nmiss n No.aFE
aq PYA% MY COMMISSION EE 055825 ieA!:°S''•, MELISAARMENTO
* er 28,2016
F�(PIPES:Dece 11c i rv+rders .: ;* MY COMMISSION#EE 855825
gond ; e4 ecem r
Revised 07/15/2014 BondedThruNotary Public Underwriters
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS