HomeMy WebLinkAboutRoberts - 8204 Kiawah Trace SLCALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 71 0 1 A t) a C)
Permit Number.
-J;-
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fart Pierce FL 34982
Phone: (772) 462-1553
Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT' LOCATION:
Address:
i 0.l-�'�
Legal Description: 0��SY�
Property Tax ID #: 33A7 - 705 - 0037 - COE) - j
Lot No. 04
Site Plan Name:
Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
SUPPLEMENTAL CONSTRUCTION LIEN LAVA INFORMATION:
DESIGN ERf ENGINEER. _ L-IN Applicable
Name:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
BONDING COMPANY: TIf Not Applicable
Name:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated_
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that t will, in all respects, perform the work
in accordance with the approved plans, 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-residential use
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 in ection. If you intend to obtain financing, consult with lender or an attorney before
ccmmencin recording our Notice of Commencement.
i
I
e of Owner/ Lessee/Contractor as Agent for Owner
ure of Contractor/License Holder
STATE OF FLORID�e i
COUNTY OF �`
STATE OF FLORIDA
•-uy
COUNTY OF
The forgoing instrument was acknowledged before me
this _U_ day of 20_(�,Qby
The forgoing instrument w s acknowledged before me
this day of u 20 by
Name of person making statement
Name of person aking statement
Personally Known � OR Produced identification
P n Z7OR Produced Identification
Type of identification
Type of Identification
Produced
Produced
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E �1NiilflllH�j��
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(Signature of Notary Public- State of Florida,���P.•""'••., C
gnature of Notary Public- State of Florid
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Commission No.GGA 19e! d f al); ���� ?�o J,l,co*_nission
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No. CYCrAq2[Do2
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REV
DATE
9 ��rltailg�ti '
RECEIVED
DATE
COMPLETED
Rev. 8/2/ 17