HomeMy WebLinkAboutBuilding Permit ApplicationProperty Tax ID #: t/-?q -!V0? _00Lot No.
Site Plan Name: Block No.
Project Name:
Name AIWAI /` fi►/V G I ory
Address: 345; 1 -,
City: FT, �e-r(' Q State: F1
Zip Code: 3 Fax:
Phone No. 7Z 972-5S-6 7
E-Mail: Ja 1V i;AJPAD,4777 eVa o1,6-
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Name:
Company: Q/'D%iAld GAr pPTs _TwC
Address: .0-gay1Z� 3
City: o Sow• State:_#'d.
Zip Code: c� -707 Fax:
Phone No
E-Mail
State or County License
If value of construction is 2500 or more, a RECORDED Notice of commencement is requirea.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: V Not Applicable
Name:_
Address:
City: _
Zip:
Phone
State:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY:
Name:
Address:
Citv:
Zip: Phone:_
Not Applicable
State:
BONDING COMPANY: ✓ Not Applicable
Name:
Address:
City:
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 I 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 paying twice for
improvements to your property. A'Notice of Commencement must be recorded in the public records of St.
Lucie County and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
with lender or an attorney Uetore commencing worK or recoraing your Ivoitce oT commencement.
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Signature of Owner/ Vlontraftor as Agent for Owner Signature of Contractor/License Holder
ir
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF 53r • X,.-6cx@ COUNTY OF
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this \0\ day of *.,N 2020 by
Q1 a .r' SC-x-'Ta•i'l
Name of person making statement.
Personally Known OR Produced Identification
Type of Identifica ' n
Produced rL ;D I —
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
this day of 2020 by
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
Produced _
(Signature of Notary P (Signature of Notary Public- State of Florida )
ell'"•':�i+: DEAN NAMARIEG&TM
Commission No. �j EXF�u AM
N#GG022023 Commission No. (Seal)
;yFcaa off,,.• tuber 16, 2020
,,,,t„ Bonded Thru Notary Pubifc Unden4 tern
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED