HomeMy WebLinkAboutKARL PERMIT APP AND SKETCHi
HE
Not Applicable
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COM
Name:
Name:
Address:
Address:
State:
City: State:
City:
Zip: Phone
Zip: P
one:
FEE SIMPLE TITLE HODr;q Not Applicable
BONDING COMPS
: Not Applicable
Name:
Name:
1/7
Address:
Address:
City:
City:
Zip: Phone:
Zip: Pone:
I
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 per
which is in conflict with any applicable Home Owners Association rules, bylaws or and covenants
it holder to build the subject structure
that may restrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for a
y restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will, in
ill 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 concurrence
review: room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses
Commencement may
to another non-residential use
result in twice for
WARNING TO OWNER: Your failure to Record a Notice of
your paying
improvements to your property. A Notice of Commencement must be rec#riled
and posted on the jobsite
before the first inspection. If you intend to obtain financing, consult with lender
or an attorney before
commen 'ing work or recordine vour Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License
Holder
STATE OF RORIDA
COUNTY OF ��Lu
STATE OF FLORIDiR►
COUNTY OF
I (
The forgoing instrument was acknowledged before me
this _Z,�day of 2021 6y
The forgoing instrument
this ,_16 day of
was acknowledged before me
f - 20 by'..
Co-r4-c*—
00�v�cl—
(Name of person acknowledging)
(Name of person ack
owledging )
(signature of Nota Public- State of Florida)
(Signature of Notary'Public- State of Fi`orida )
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification l
t `*�•'�
Type of lden 'fication
ti r �� .. HASSNA 5AhA39!A
Produced tc c�c
�t
Produced : .. NAsshA S�
r•' .k' Notary rlubk Std,
won » 734D321
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v 5lr[ State of Fioripa
,J ��� Corrmission = GG 3403Z7
Commission %l0_ �My CCel rres Juf Ze. 20I3
Commission No. ,5"
y o m. Exairr23Soreee
thro vh Na fora; Notary Aw,
Dorleee throL;h %dtiors. .
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 2014
I '
Ail APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED!
Date: Permit Number:
I
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR:
rt M111
Address:44_mshL V ql F t ( �_el
F(l 3
Legal Description: 66 3 Y 3' rKd Javt s-;:f i✓ S
Property Tax I D #: 3 0(OL Y - 6 o U.)-
Lot No. 125-
Site Plan Name: Lac iI � ,g_S } - wcoeEg
Project Name:
Block No. F
Setbacks Front Back: Right Side: Left Side.[
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- .., ... .fix..-.. ....., � .,. ..�.W..
Yc,�, � >ti 4' !a C( 3ai
C ca i
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......-'�$�.e�� -:
Ad app y:
nawor"toapeormeuner tis permit- c.itioeCK all thatapply:
Mechanical _Gas Tank Gas Piping _Shutters;
Electric —Plumbing _ Sprinklers — Generati r
Total Sq. Ft of Construction: Sq. Ft. of First Floor!
Cost of Construction: $ �Od_ Utilities: Sewer _S6ptic
Windows/Doors
Roof Pitch
Building Height:/
Name k ee C/3 L a K 1
Name:
G'�f�l � y
—��r - - - -
Address: ( 3 e r S/2 zi lkf I Vd .
Company: yr - Y� mw (OM t'✓e�
q
Address:l� !�
City: ,�),/ Stater
Zip Cade: �� y S' Fax: _/f f 77
City: State;
Phone No. �3! S`- 3f--/,0'
Zip Code: 3 Y' Fax:
Phone No
E-Mail V_ C::� {/
E-Mail: I A
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
State or Cou y License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
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