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HomeMy WebLinkAboutBuilding Permit Applicationr= Date: Permit Num r. J qj ®L4 Building Permit Application Planning and Develapmeasemen BuHding wW Code Reg &Uon Division Commercial Residential 23W VirginiaAvertuei Fort herm FL 34992 -Phone: (772) 4621SS3 Fax: (772) 462-1578 PERMIT APPLICATION FOR: Address: 103 FOGY C EAR Property Tax ID #: 4509 1901 o oo .o ©Q 3 Lot No." .3 Site Plan Name: l MP- OAjc5 AT !fj/3t,W ,k d IfEa Pj-%Ey tie? it 13 Block No. Pr§ject Name• E&K L-N /�� �Ae�rT� ®G�i4>fvr/V�S ,, sQR�5se�6z�iRE�i�I�S"TRI�cr�R�1� New Electrical Meter %W Ci Second Electrical Meter Af0 (F -o -n �� n n Additional work to be performed under this permit— check all that apply. Mechanical _ Gas Tank _ Gas Piping —Shutters —Electric. —Plumbing _ Sprinklers Total 5q. Ft of Construction: 3 Cost of Construction: $ 4000__ T_•_ —Generator _Windows/Doors _Pond Sq. Ft of First Floor: Roof Pitch Utilities: _Sewer _Septic Building Height: r y� tw­ ._ z. .. -.... 'c—. ,.x .,-v.:i-++-_.....+..." -.:.5_.-..r r. , X ..'r:,. . Y-l. ."-.s - w � try - n1?!�- ... v�,L i'r. - r[>. ./ts-" t 4 4 V •?• Name_ J e Ai A T JV A-*v 17 Name: Address: 1 03 EA ZOV Q&& ft iLO Company: Ctty: j f.WS: EW fF-Aeh1 State: Fd Address: Tap.Code: Sg9S -7 Fwu City-. State: Phone No,� ' 9 -Srq 9.31 0 3 1 Zip Code: Fax E-Mail: A �J 11 A'y OV I A O a r,,6 P4 Phone No Fill in fee simple rdle tlotder on rt= page (if di< awa E-Mail from the owner Ust+ed above) State or Conntlt License a•ratweOF�at5 ffvahWafHMCts$7,Metn=rv,a I wjtf§nqUft& DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: Not Applicable Name: _ Name: Address: Address: City: State: City: State: Zip: Phone Zip: Phone: FEE SIMPLE TITLE HOLDER: — Not Applicable BONDING COMPANY: Not Applicable Name: Name: Address: 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 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 YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE J013 5aE BEFOO THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOU,9Z)LENDEJeQfi AN ATT,4RNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Signature Own r/ Lessee/Co;Actor a Agent for Owner Signature of Contractor/License Holder STAT OF FLORIDA STATE OF FLORIDA CO NTY OF �����,Q� COUNTY OF The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me this day of 20_ by this _ day of 20_ by Name of making V Name of making statement. person statement. person Personally Known OR Produced Identification Personally Known OR Produced Identification Type of Identification / Type of Identification Produced Produced (Signature of Notary Public- StatVof Florida) (Signature of Notary Public- State of Florida ) Commissional Commission No. (Seal) .yp"" ELLEN VAUGHN of F REVIEWS o °,' yir? "/',PWONT Y i .ission # GG 2 c � On Ex p u is , E ISOR PLANS I VEGETATION SEA TURTLE MANGROVE o r 20 2 RE W REVIEW I REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev.