HomeMy WebLinkAboutBuilding Permit Application r
All APPLICAUE INFO MUSF HE COMPLErED FOR APPUCAnON TO RE ACCEPTED
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- _ SEP 2 12017
Suldlng Permft ApplwVon
PERMITTING
Planning and Development Services St. Lucie County, FL
Building and Cade Regulaffan 0N�
23M WpirtsitadAwAue,FG1 tPOYCC F.34—
Phone:"))4W--1553 Fmc�772D 462-1578 Commefrdal Residential
PERMITAPPLICATION FOR:
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Lot ft-
Legal Description: (!�
Site Plan Name: Block No.
Project Name:
Selharikcs ►Fwmm Ian tSale: aeffit&de:
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_Mechanical _Gas Tank _Gas Piping _Shutters Windows/Doors
Electric _Plumbing —Sprinklers —Generator ✓ 8toof 3 1 cA �,,7
Totafl Sq.!Rt of ConsWacnon: /SOD Sal-F.of Fht FD=rr: 1061
Cost of Construction:$ e!!&0,6,6j60_ Utilities: —Sewer —Septic Building Height:�p 1
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Addrow. Company_
City: ab State:_ Address-
Zip Code: Fam Caw State:��,�.
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E-Mail: Phone No
Fall in fee simple Title Holder on next page{if different E-Mailit
from the Owner Ested abmm) II State or County U ense
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t lG�9E�/ t�9� [�41ot ApPAucabBe !�#O �� Q Q�®t A�lu�1�9e ,
Name: Name:
Address: Address:
City: Site: ( State:
Zip: Phone 25p: Phone: �
FEE SIMPLE TITLEHOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Addre:
ZRP: Phome: �iip: 1iro�:
OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permit to do the work and installation as indicated_
A any that nn .Tk or instomfian has commenmd:pfw to the fisgase off a peimrCL
St tlwuiie Cum no mm anal is{gmufur g a prtrnii+it wrn�i 9 au rf�diie Mideir iio boU the sa kpa s Mrn�ihuirte
aaahhfia h 55 mil i'iri vrr+ift amray applli�a IES Ow AaBwa mm rruillimi,b*Ians or wd mmmuts dot imi> W ffestni at or pmdhiIh t sm dt �
sltr=Uum P'ksse mnsuit vATh kyeiur He-me Oirrree?s Assadabon and mnew your deed fur any m5inchans whvdh May appify_
In consideration of the granting of this requested permit,l do hereby agree that I will,in all respects,perform the work
in accordance vAth the appmued plans the Florida gugffing des and St_Lucie CoaunetV Amendments-
The follawimg bUMffm g penrdt appScad nns are ex-=mpt ifmni undeWn a ffulM cm=zffenW re,§ew-_nxmnr ad
AWL-SlInKftnesi,Semn'og PG94r.9bMmr4,ut 0k Agri,gram rrcmmm aamdl aamgmw upsm W amv&er na sreir "ail ura
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 f mt inspecthm.If You intend to obtain finanean&consult wM lender or an attorney before
commencing work or recording our Notice of Commencement/
1
signatuid of Order/ Ag Signat a ctoriUcense Hlo
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j� STATE OF RJORJDA Sll'A-rE OFRADA
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ri t�A1 til ,
The for oing instrurpent wcknowledged before me The Wiling instru ent w acknowledge _before me
its ate+atDf �� � this d day of � �
Lie
(Name of pe on acknowledging) (Nam�o�persAnn acknowledging)
t 6 0 A I VA I L
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amif iRtttinf>i�uut 1�Ste- ruff l 6ffEb y ((59urae of KIGWV ti°ubii-S=e a i%tiidia�
Personally Known OR Produced Identification Personally Known OR Produced Identification.
Type of 9demti TW of lalmfifi _ F,
PmdUa�t
tuned �I
;�;;.p�••;;•,, KAREN S. NIELSEN I •""" {i
Commi� +�'".�` _� (iQREN S. N
FF 115637
Cemtrunr i�cn[t��_ _ �.` missi IELSE'3
My Commission Expires _a on#FF 115 3
,,urns. •�
June 12. 2018 �%,,;oFOFM�.�' y Commission Expir s
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6dIE!/98 W5 FRONS' ZONING SUPERVISOR PLANS VEGETA-1 ION 1 SEA TURTILE WMG .1
j; QaUNITER ; IRilEVIIIE 7 , REVIEW REVIEW REVIEW REVIIElW REVIEW
DAT
RECEIVED
DATE
C®MPLETIM l
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