HomeMy WebLinkAboutBuilding Permit Application i
• MUST BE COMPLETED • , • •
BE ACCEPTED
Date:
Permit Number:
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t' L [b h [ U •
RECEIVED
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Planning • • Developmeni
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Building I r •r Regulation 1 •
11 W910 iAvenue,Fort ..
+2-1553 Fax: (772)462-1578
Comm ' Residential
PLICATION FOR: To- Select from dropbox, click arrow at
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DESIGNER GINEEtt: Not Applicable
=GAGE COMPANY: Not ApplicableName
Address- Address:
City: State: city: State;
Zip-, Phone: Zip: _Phone:
FEE SIMPLE . +TLE HOLDER: �Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address_ Address:
City: City
Zip: Phone: Zip, Phone:
I certify that nc ork or installation has commenced prior to the Issuance of a permit.
St. Lucie Count akes no representation that is granting a permit will authorize the ermit holder to build the subject structure
which Is In con with any applicable Home Owners Association rules,bylaws or angcovenants 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 consideratio of the granting of this requested permit,I do hereby agree that I will,in all respects,perform the work
in accordance #h the approved plans,the Florida Building Codes and St.Lucie County Amendments.
The following 13 `[ding permit applications are exempt from undergoing a full concurrency review:room additions,
accessory struc 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
impCovemen to your property.A Notice of commence ent must be recorded and posted on the;obsite
bef e the fi , inspection. If you mend to obtain finance ,consult witp lender or an attorney before
com. encin dingy r Notice of CQmmen c erit.
Signat re of a see Sig a ure o Co tra ice se Hold
ST OFF RIDA STA E OF ORtDA
1 .`
co U O COI,[ T OF �u
The forgoing in ment was acknowledged before me The focgolnginstrylmentwas acknowledged before me
thisday 20 idoy this
` niA 1i �'
o R+V)e—
ame of per cknawied ing} tName of p on acknowled Ing)
natureof •ary Public-State of Florida) i51 ure of Notary P Ic-state of Florida j
Personalty Kno """" '� 1 on ersonally Known a a(h# P�oduceec �C
Type of identification 11 - % ., •,�.af:4
Type of identifi ion Produced ;.Y^!NE fiiUSSELL _�
�" is•Sfate of Florida h: x kres Jul 22,:2017
Commission N. . " Commission No. t
f 1,; tis lti�017 yCOinmi yrs Fi 03882
F ':•; FE 035382Gcrnmission#
i
Revised 07/ : '12014
REVIEWS FRONT ZONING SUPERVISOR
PLAINS REVIEW VEGETATION
SEA REVIEW LE MANGROVE
.COUNTER REVIEW
HATE '
COMPLETE
MITIALS �'I