HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INF®MUST BE COMPLETED FOR APPLICALTION TO BE A
Date: --v-��--� PermitNumber. b 1
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BuNding Perms Applkadon
Planning and Development Services A U 6 19 3
Building and Code Regulation Division PEP,�irlTTi G
230 Va-ginid AwaLw,F'ortMemeFL34 St. Lucie r'0i'niy, FL
Phone:(sem)462-1553 Fmc(772)462-1579 Commercial Residential
PERMIT APPLICATION FOR: 5�1� �LA ( 2!-
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Legal Description: Z �-
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Site Plan Name: Block No.
Project Marne:
Setbacks Rant Badc tR&Sade: lit fie:
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e € ' .5e.h-� ,?�+. .:
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_Mechanical ,Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric —Plumbing _Sprinklers _Generator vlli�; -
Total Sq.ft of Conshuction: _ 0 Sq-IFIL of RPA fir- Z(F, `SA
Cost of Construction:$_ Wig i O o Utilities: —Sewer _Septic Building Height:
74®f 1' K$f�R1// - t '✓r S Sc $�'S y�.4 K -y
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name L If�lm
Addre 3l'7 L Company: (,
City: l State Address: 101 C:
Zip Code:, FMC Cir- Statre��
Phone Nv.27Z ZFr, + Fax77, -��DELA! >
E-Mail: Phone No 7 —(1.5L
Fill in fee simple Tolde Holder on nett gage{ff diffenamt E-Mail
from the Droner Bsted above) State or Co - rise S
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If value of construction is 2500 or more,a RECORDED Notice of Commencement is reqd1rect
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DESrIGNER/ERGI Not Applikable MORTGAGE COMP kot Applicable
Name: Name:
Address: Address:
Cd: State: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: _Not Applicable
Name: blame:
Address: Address:
Zip: Phone: Zip: Pte:
OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permit to do the work and installation as indicated_
I certify that no=rk or instaffation has waimenced prior to the isset of a unit_
SL WoeIrma no iia tat rs a ua�m"til " Um " I to the
vet &,i�ism I'1m i fn aM ale ftme Oxfts Aigmatm njh5,b&as aramd ammargum got amy tr umt or
structure.please consult vAth your House Owners Association and review your deed for any restrictions ich 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 uft the approved plans,the RoMa Building Codes and St Nude Gmmty mss
The follmving bum permit appilications are exernpt from wNhWE'ding a full cwxmnmxy ram room
aamspMW " ll wait ftrnr�,srmam mm ms and ammsnay e1 Wmmm4e-mar&d WW
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 'on_Its you intend to obtain finandn- consult a A[h lender or an attorney before
cpm a cite work or recording our Pdotire of Commencement
ljk,
Si a of Osrsner/Lessee/Agent Sigasatu f Contractor/Liceaseolder
STATE OF FLORIDASTATE OF R.ORID,!!
COU OF ` GOUNTYOF A. Llo.fr.
The f r oing iment was acknowledg?�efore me The for ping instru t as acknowledge efore me
this day of lz�——�m10 by thisday Gf 21�V by
(Name of p rson acknowledging) (Name of per n acknowledging)
Ci , f9
(Signature off�lotary PubSc State of Florida / (Srgrtature og Notary Panic State of Florida)
Personally Known OR Produced Identification v Personalty Known OR Produced Identification i/
Type of Idenfifigirm of Idols4�fc
Produced ,;aY I<A i2 k N S. N I E L S E
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3 ➢ *: Commission 4 FF 1156
Commission No. yG �`; M Commission Fxpir s Yu�rrnv KAR �g1E`.SEN
o (SQ)June 12, 2018 Co mission No. ,';`"""°�Or CommisI SCA P 11 of�y
My Commission Expires
Juno 12, 2018
REVIEM FROW ZONING SUPERV60111 PUNS VEGETiATnV SEATURTLE MANGROVE
CQ UNER RENEW REVIEW RLVEW REVIEW RMEW- REVIEW
DATE
RECEIVED
DATE -
COMPLECED