HomeMy WebLinkAboutBuilding Permit Application (.____-,.-__.-
plicable
D . -__
Name: � Narbe� -
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: _Not Applicable
Name:
Name: '
Address: Address:
C�� City:' Phone: Zip: Phone'
Zip: - .
OWNER/��y�0��R AFFV���p|i��b�������na����t�wm�a�����n�i���.
I certify that no work orinata|bdonhascommenoedphurtothebsuanoeofapennit
permit.
St. Luciahes representationthat�0 h permit
the structure
which iyinoon� ctwith any licable Home Owners Aion rules, bylaws or and covenants that may restrict or prohibit
such.
structure. Please consult with your Home Owners",,""""..andrev.emyourdeedforanyreshcdonswhich may apply.
In consideration of the granting of this requestedpennit, idoherebya ll,iU �r� mthe work
in accordance with the appplans,the Florida Building Codes and St.Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review:room additions,
accessory structures,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residentialuse
WARNING TO OWNER:Your failmmeto Record mNotice mfCommmnemmarnemtmnayresult inyour paying twice for
improvements to your property.A Notice of Commencement must be recorded and posted on the job
site
before the first inspection. If you intendto obtain financing, consult with lender or an attorney before
commencing work orrec�r�inAyourNoticeof
Commencement.
•
(p/4,, , -
Owner/ Agent for Owner Signature
of Contractor/License Holder
STATE OF FLORIDASTATE��F FLORID __
C��������� — , ��^ COUNTY OF
The'org"inOi gzu en1vv9sacknmw|edQedbeforeme The forgoing instrument was acknowledged before me
this day
^f \ , 20 17 by this day of '2Oby
• 10id/ /
—74111111.
(Name of person acknowledging) (Name of person acknowledging)
lc,~~~__ ���
I
i
~A�� � �^ A . A- -4 ~
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification V/ Personally Known OR Produced Identification
Typeof|dendficm�ion
Type nf|dentif�aton
Produced 0 _' '` _ _ _ _ __ �p�pduced
..
KAREN S. N|ELSEKJ'
Commission No. �oaem/no/o^# Fp11»aa_r� mission Nn
' (Seal)
My Commission Expires '
June 12, 2018
�
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ley.7/2014
.