HomeMy WebLinkAboutBuilding Permit Application LE INFO MUST BE
• 1 • APPLICATION TO BE ACCEPTED
Permit Number: 0
RECEIVED
Building.Permit Application AUG 2 4 2016
t L C3' R , IU iL
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76de Regulation Division
Avenul e,Fort Pierce Fz 349s2
1"462-11553 Fax: (772)462-1578 Commercial
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State: r .. - •_ter'. ,cam IN/Mi
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Zip Code: • r
Phorie No. ! , _
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Title Holder on next page(if different
i listedabove) • aMA 11K4I
I
� I
EWEN
rAddress-
SIGNERA GINEER: 7Notpplicable MORTGAGE OMPANY: Not Applicable
me: Name:
Address:y: State: City: State:
: Phone: Zip:�.__.__-Phone:
FEE SIMPLEITLE HOLDER: _Not Applicable BONDING COMPANY, JNot Applicable
Name, i Name:
Address: 11 1 Address:
city: I city:
Zip: P hone: Zip: Phone:
I certify that n :work or installation has commenced prior to the issuance of a permit.
5t.Lucie Coun `:makes no representation that Is granting a permit will authorize theermit holder to build the,subject structure
which is in con ct with any applicable Home owners Association rules,bylaws or an9covenants that may restrict or prohibit such
structure.pleas l cons 'It With your Homeowners Association and review your deed for any restrictions which may apply.
In consideratio of the granting of this requested permit,i do hereby agree that 1 will,in all respects,perform the work
in accordance th the approved pians,the Florida Building Godes and St.Lucie County Amendments.
The following b iiding Ipermit applications are exemptfrom undergoing a full concurrency review:room additions,
accessory strut res,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use
WARNING T OWNER:Your failure to Record a Notice of Commencement may result In your paying twice for
imp ovemen to your-property.A Notice of Commence ent must be recorded and posted on the jobsite
bef a the fitt in;ection. if you ntend to obtain financI consuit wit lender or an attorney before
tom encin din r Notice of Commenc ent,
i
Signat re of ee . Sigt ure o Co tra ice se Hold
1
STAT OFF RIDA LY_-' e. COU E OFOFORIDA
COU 4
The for cling in tru an was ac wledged before me The forgoing instrument was acknowledged before me
this�ay o zo, by this�day of�+�}�Zodoy .
( am rso acknawled ng) [(Name of 'son Beknowie ng)
ature of Not Public-State ofFlo�rtda �,�,,,�,
gnature o to P�tt3(Cp Mate of Florlda i. .
i,, `,c,- JERALY NE RUSSELL
"�' ` � pts,{ &VIorida personally Known R , soduce �d� 4L
Personali}t Krio n �' „ 'pr y urnm xp res Jul 22. Type of Identificat10 £rr : Notary Public State at Florida
Type of Identifi ati ni,,r,o➢f`�,.� - " 22 any Comm.Expires Jul
Gommi 5ipp FF 036392
Commission NMOTCommission No-'',
i
Revised 071 :512014
REVIEWS FRONT ZONING SUPERvlsoR RPLANS EVIEW V 5ETA►ION S ATLIRTLEREVIEW M4tEVlEOVE
COUNTER REVIEW REVIEW
DATE
COMPLETF
INITIALS