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ACE APPLICABEE INFO Iolus i BE CUMPLETED FUR APrEICAI IUN i O BE ACCEFi ED
Da►e:
Permit Number:
w a
Building Permit Application
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PtRMIT APPLICR I IuN FUR: To Selaut from dropboA, click arruvu at the e, id of line
PRuPuSED IIOIPRUvEmEN I EuC—Ai luta:
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Segal Description: a,fb
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I(I (I nm rnan e i crn P
Property Tax ID #: , i t a2i-'5Q1 'CXX03 .000 ` Gi
LOL No.
Site Plan Name:
Block No.
Protect Name:�e��1��C
Setl5a.L Fr.nt tsacR. Richt Side:
Left Side:
DETAILED DESCRIPTION OF WORK:
Perince AfE eyxcd-F ehune vuf
Wi-rh ;�7 +D,j Iq Seer
�5gW
A1C un. -r.
CONS I RUL I IUIa IIVFORIVIA I ION:
tion„ .Qr tv vrRtc en art i� p�r�it—� ce
❑FIVAC ❑Ga;Pipi,.a
a aPN r�
❑Windows/Doors
G; -.z ianR
_Shutters
UElectric PIUMO'% 0SprinRlvr3
1 U.nerator ❑ Roof
moot pitch
I viwl SN. Ft vT Cc ... U 5ctivn:
5 . Ft. of First Floor:
[--]SepLic
Cas► of Construction: Lp . Udlides:
Sewer Building Height:
uwM EK/EtSSEE:
CuN I RAC l UR:
(game
ivame: ann i a ZLLC PSL
a
Address:
Company: 6 to s
cd LS
Ci.y: SLaLe: _
Address
i.ip Code: Fax:
City: Nkb
staie:_L_
PRo..e Igo.
cip Cvac: ; �t[� FaxCJ_27� - yr�
E -Mail:
Phone No. I C? !Ll G -
Fill in fee simple Tile Holder on neAL page { if different
E -Mail:
from the Owner listed above)
s;ate or Coun y license: e24tl 1;;RjL%QL5�-S
IT value o, construction Is $zaaU or more, a RECORDED notice or Commencement Is requir�a.
SuPPCEMEM IAE LuM5TRu—L I lulq LIED CAW IMFuRMA I lulu:
L)tbI(aNtK/tN1bINttK: X Not Applicable
Name:
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: = Not Applicable
Name:
MORTGAGE COMPANY: x Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: NOL Applicable
Ivame:
City: City:
Zip: Phone: Zip: Phone:
I ecrtify tRut nv :vrR or inzit..11..tion M., caRlmcrlee8 prier to the f,;eoncc at . perrnit.
St. Lucie County makes no representation that is erandns a permit will authorize the -permit holder to build the subject structure
-nieR :3 iM eonfliet WitR ..R, a plico6le Rvrnc 0 ricr., Aszoel..[ian Mica, o,l. :. yr oFd ceTenont. Out n+.r re3tri..t or proniSit teach
structure. Flease consult wit your Rome owners rtssociadon anU review your tieeti for any restrictions wRicn may apply.
In consideration of the granting of this requested permit, i do hereby agree that I will, in all respects, perform the worn
in accordance witR the approves plans, the Horitla Ruiltiing Cotes anti at. Eucie County Amendments.
I R. tollo drgs Sailairng purrni[ ,.re cncmpt rropm enticrgaing . tell earicei:rerle, rc.ic rowan .13i3ition„
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-resiu'ential use
vvmRNINO TO OWNER: Tour fallure to Record a Notice of CommencemenE may result in your paying twice Tor
improvements to your Nruperty. A Notice of Commencement must b:= recorded and posted on the Jobsite
Before the first inspection. If you intend to Obtain financing, consul[ with lender or an attorney oeiore
commencing; work or recurdinx your NOticc of CummCncement.
1 ' _
_ z,ignature of C er/ [essee%gent sign,.te.-c at Flalaer
STATE OF FLORIDA
Cor IV I T OF SQL
IRcing in�trarncr.t ocRna-Ica 6cto. c ITrc
tRis 'day or I �n� my
O.Rmi; Z.00k
(ni-. —e or pe. wn )
STATE OF FLORIDA
CCIUM I y OF S1 L6..
The foreoin6 instrument vas acknowledged before me
tRis F Bay of A ,moo oy
Demi= ZA.uk
(Napnc at person aeRna :led6ins )
. -in] klo. UbO
+ham ►
a,ure of Notary PiN.s-State of Florida) (bign..terc or Foto.; Peolic- tc Qt Florida )
Personally Known - UR Produced Identification Personally RnoWr. X OR Produced Identification
Typc of ktcrititic.tion Prvaacca i ype or Itientitication ProtiACeti
Commission No. FF22093 -;: : - ISM A DEKBT C-mmi.3ion 19.. FF220930 :`•' �S TH A DERBY
My COMMISSION t! FF2209w 'c MY COMMISSIO,Y q FF22
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COUNTER
REVIEW
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REVIEW
REVIEW
DAIE
COMPLETE
11911 IAES
Site Addre
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Prep=rty Ids.-,tiflic-tion
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OCEAN I IARBOR SOUTH FILD ; A UNIT 867 AND UNP INTEREST IN COMMON ELDIENTS,OR 1 14114h.1 2918
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