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PERMIT APPUCA IO FOR-- TO Select from dropbox, crack arrowat the end of One
PROPOSED OIC;
Addren: St.Lucia-M52
Property Tax it$ Lot NO.
Site Plan Name: air No-
Project dame:
setbacks 1:r®rat RznclL Tf2ght S3ceo_Sit Sine:
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UHVAC Gas Tank teas Piping Shutters Elndows/Doors
1112c C1 Pleats b5 ng Ljspiinmers OGenerator Rooffr
Tow Sq.Ft of ccb%mnom Sa.Ft.of First Floor:
Cost of 2onsi fwn-S �� fl.tdra lless Sewer USeptic Building Height:
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Addy s-. Ai$Swab US 1,Sift 402 Company.WOM D&WIPPOM)t CvYporaon
CIty:Port St.LU state•�!:_ Address. BODO South US 1,She 402
Zip rode. Tom. ���� :.P -SL Lude State-Ff-
Phone Mp Cove:3051 FMC 772-87"224
E-Ma!1:-5ua,@%,ynrbbcr-o7n Phone No.M-878-WIS
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1 ..;.1GPjff-1R.fEi 68NEERd mot Appricable MORTGA F-COMM V: i NetApplicable
Name: Narrie-
Address: Address.
State: C^ state'.
Citr: Phone: �-�
Zip: Phone: ZiPZ '
F �����N�����A��, met App6itable� v � �
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Name' Name:
Address: Address:
city.° Ofty:
Zip: Phone: Zip: Phone- .
I certTy that no work or installatson.has commenced prior to the issuance of a.pernrai't:
St.Luc"se.Count�r makes no represem*m�:isgrantiirlga Pewit wiR authafte the raerrrait holder to build,the subject staarcture
which is'i"eor llr let -airy appli�ble Home Owners Association rules,bylaws Oran cove�antin#t may 3�ffct.orprohibit such
structum,Please consult +your Home .ersAssooation and retdevv your deed for any EM-1 tions sviu�may apply-
In•corSidgr ati€un Of the granting aWls requested permit,'I do hereby agree'that I uAll,in all respects,perform the work
in accor4anm with the appromd plans,•he oda 8011ding Codes and St..Leap•County Amendments.
'i'be fel4ot 4rigbuu'ilding pennft apprscavcms arexozemptfrom undergoing a fell sarnraa Tency revlgsv:room addWosns,
aw-essary structww'spa 7¢z pastils,fees,;s�-alls,signs,seen rooms and assessor y ams•tai atter non-residezedai use
VyAAN#K6 7.(D(Dw a your JegRum t ie Pacvnd a byes of .u5iwman it g m an vow Pw ang swice.or
improvements to your Property.A•Natice of Cert ericenieri�srv�s�$�r��a�� � pa�st�d�&�the�¢�bsite
before the-rstinspection.if you intend to obtain financing,consult with fenderor an.attom-ey before
.co mmend. w or recardlog Inur.HaVice of Commencement,
_SWature.arf owner iesse-WAgent Signature of Contractodtaceaase Holder
COU1W'OF e..Uy;--- COU ��
"The forgoing inawment was acttrncsMedged before me The••fiorgoing•instrument was ad=udedged be6re me
this \;:;;-dW _..� 20�a--w this" dayof 'b•
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Plante of Pers a l<riowledga€�g� {l+arrre csf Pers oti Ie€Iging}
.-(5igraa re•of Notanf1Putaiic State of Ftori 5sgrta sm of Notary pubifi S a e of FI da.) �
Personally Known OR Predu. Iden on Persou-ially&€rcornsrn OR Praduced'IdentMcatio n
Type.of Iden'etmqAtion'Producel TYPe of Identification Produced
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