HomeMy WebLinkAbout910 nettles permit.pdfALLAPPLICABLE INF MUST SE COMKUM FDR APPLICATION TO BE ACCEPTED
Date- 02 Permit Number_
S _ _
s
Building Permit Application
Planning and Develapma&Servkn
Building and Cade Regulation MwOA
2300 VrgkgaAvenue, imtPle►ce FL 34M
Phone: (M) 462-1553 Fax: (M) 462-15n Commercial Residential
PERMIT APPLICATION FOR: To Select from dmpbox, dick arrow at the end of fine 'll
Address.
Legal Description:
Property Tax ID # yS-o�- S� (- /U`�� -ooa -Z ENO.
Site Plan Name: Blodr No.
Project Name -
Setbacks Front Back RW tSlde: Left Side
Ae.r14-c
CONS ucnON'INFORMA770N: tI,
Electric
Gas Tank
Plumbing
Pip (('S
hutters C]WIndoww'Doors
nkiers D Ge aerator O Roof
Total Sq. Ft of Construction:! FL of first Floor.
Cost of Conduction: $ W Utilities: Sewer ❑Septic BuW" Height
OWNERiLE55EE:
CIJNTRACTOR.
Name f12rv,',A Qios.r 0»,4
Name: John RLow
Address: a�/!
Company. Lays EkftW Swilm ink
City: S e rr c r. &eor c, 4 State: �
Zip Code: 3C/9 S Z Fax
Phone No.G / t" / — 3 6,
Address: 5158 NW Primm St
City PT ST Lucia State
Zip Code: 34M Fax:
Phone No. 772 370 4357
E-Mail:
FBI in fee simple TMe Holderon neat page (N difFarmrt
from the Owner listed above)
E-Maih Mi1 corn
Starve or County License: 2'
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SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION.
DESIGNER NGINEER: _ Not Applicable
Name:
Address:
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
City:
Zip: Phone:
State:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: — Not Applicable
Name:
BONDING COMPANY:
Name:
_Not Applicable
Address:
Address:
City:
City:
Zip: Phone:
__" __1 ac indi"t'Ari
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permii Lo aV 1=rim,—
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie Cauntv,makes no representation i no a �iswgras Ps ratiomndrules bylaws or an, covenants that may restrictbor proect hibit such
which Is in conWict with any applicable
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
iin n accordance with the approved plansranting of this , the Florida equested u permit,
Codes and St. Lucie County Amendments.
The the woriz
The following building permit applications
fences, walls,sisigns, from creen rrooing a oms afull concurrency review: room additions,
nd accessory uses to another non-residential use
accessory structures, swimming
p
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 inspection. If you intend to obtain financing, consult with lender or an attorney before
Agent
STATE OF FLORIDA
COUNTY OF
The forging instrument was acknowledged before me
this I -day of OGE .2Q. I by
Name of person rijaking statement
Personally Known OR Produced Identification
Type of Identification
Produced
STATE OF FLORIDA
COUNTY OF
Theforfyinginstrume�wa acknowle20gedeef�oreme
this I day of
Name of person rgaking statement
Personally Known _ i OR Produced Identification
Type of Identification
Produced
_ I -
f Notary Public States
(signature of Notary Public- ate
FtACHEL DAVIS1
..., 3 No
Commission No. t V. , , z MY COMMSSSto ✓.�
pia f EXPIRES.lanui iry 5, 2019
REVIEWS IRONT ZONING I CO NTER I REVIEW I SUPERVISOR
R REVIEW VREVIEWON
Rev.8/2117
FtACHEL M
MY COMMISSION