HomeMy WebLinkAboutBuilding Permit Application ALL APPL LE INFO MUST HE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: Permit .• i 09
.�r ` ! g PermitApplicatio,
Planning aDevelopmentservices
Building and&d Regulation Division
2300 OrgIni,lAvenue,Fort
Phone: 462-1553 Fax: (772)462-1578
Corrim6rcial
Residential r , y
PLICATION FOR:1
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E-Mail: Phone No
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DESIGNER/ GINELR: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name; Name;
Address: 11 Address;
City: ! State: City; State: --
Zip: -Phone: zip: -_--Phohe:
I' •
FEE SIMPLE '. TLE HOLDER: �Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address: i
City: City:
Zip: Phone: Zip: Phone:
i certify that n,work or Installation has commenced prior to the Issuance of a permit.
5t.Lucie Count"makes no representation that is granting apermit will authorize the ermit Bolder to build the subject structure
which is in con ct with any,applicable Horne owners Assoclation rules,bylaws or an9covenants that may restrict.or prohibit such
structure.Pleas consult with your Home Owners Association and review your deed for any restrictions which may apply.
In COnsideratior of the granting of this requested permit,I do hereby agree that I will,in all respects,perform the work
In accordance v th the approved plans,the Florida Building codes and St.Lucie County Amendments.
The following b ilding permit applications are exempt from undergoing a full concurrency review:room additions,
accessory strue ires,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use.
WARNINGT( OWNER:Your failure to Record a Notice of Commencement may result in your paying twice for
imp ovemen s to your property.A Notice of Commence ent must be recorded and pasted on the jobsite
bef a the fi t inspection. If you 'mend to obtain financ! ,constwitd'er or an attorney before
com. encing ding Ar.Notice of Commenc ent.
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Signat re ofI ssee sig a ure crCo tra ce se Hold •
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STAT 01^t" RIDAy�,�'� CQU E t}QFQRiDA j
The forgoing ins meet las acknowledged before me
The forgoing int t was acknowledged J�efore me y
this ay 1 this ay of _1y
o
(Naf so acknowledg` g) (Name of per on acknowled g)
lgnature of Mary Public-51 ate of Florida) ( ' azure of Nata ub(I c-State of Flan a)
Personally Kno nr „"rf Oft Produced ldentificatlon - Personally Known OR Produced Identification
Type of tdentign�►'' ' - "` _ Type of Identification Pfedu
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"' JE!� YP BaSSE
r it:RALYNN RUSSELL commission No. "r }b,'� 11
Commission N °ut�Iicioi Florida = Notary. u c-My ct,;nm.Expires Jut 22,2017
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Revised 07qr
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
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