HomeMy WebLinkAboutBuilding Permit ApplicationPfaperty Tax iD.# 17aI 6*01
Site Pian Name
Prgject Name /ti
xew veFtrtcai.Meter fiecancl;Electrical I1Meter (t4ffidavit required):
AdditionaCwork;to i e perfocmgO under this permit —check all that' apply::
Mechanical. _ GaS Tank Gas Piping _ Shutters uVindriyirs
_ Electric _ Piumi iing � Sprinklers Generator Roof
'Fatal Sq. Ft .0f Construction., $q Ft'of:,First'Floor.
Cost of Construction. TZ da.. € . ... UtdIties _Seater Septic Buil
y
Marne a. - Rj1f f""O e' Names
a
Address: I Yoo tof'r C'eme am
city r' t? rc state: )0
Zip`Code� Fax:'
Phone No. E
Mail-
Fiitin fee:sirfiple 7ifie bolder on next page (i different
from the Owner Csted above]
If value of construction is 26Q4 or more; a RECOEtt)ED Notice of C
tfvalue of HAVC s$ ,500 or more: a REC09bt Notice_of'Eamrn
Eotft.:
Pond
Pitch
!~ MajlIc
P4tgt�_ lam?
State or Courity License Mm
I
ime" ementis'required.
icemdri,t is required.
'FEE.SIMPEE'TITLE HOLDER: Not Appiicable BONDING: COMPANY: _Not Applicable
Name Nartie•
' i
Address: " : Address: . 1
City: _
City:
p• Phone: Zip; Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to dbtain:a permit to do the work and installaiiop as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit:
SL. Lucie County makes no representation that is granting;a permit will authorize the. permit holder to build the subject structure
which conflicts with an �r applicable Homeowners Association rules; bylaws or and covenants that may, restrict:or prohibit such
structure. Please consu t with" your Homeowners Association and review your deed forany restrictions which.may. apply.:
In consideration of the gppnting,ofthis requested permit,1.do hereby, agree that l will, n allrespects, perform the work
nce
in accordawith the a roved plans, the Florida Buildin Codesand St. Lucie County Amendments.
The followingbuilding 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 odtain financing, consult
with IPnelar nr nn attnrnow hcfnrn risen rr.nnn:Rzs . ...L•... ...,t:...r .......I Pt..b:. .,C f`... «�
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORI
COUNTY OF Q
Savor� t�o�, (or affirm di a d subscribed before me of Physical Presence or Online Nota nation
this _ �!z dayof = 20 by
i
�"
ry J
Name of person making statement. 1
i
Personally Known OR Produced Ide tification
i'ype of I fi n Produced---,�,�i�
""
(S3gri'atureof No ry Public- State :ofFlorida) kpr v a.,r osepil Gi11BZ
(i0(illlli$Siijr ; EG1dt4�134
Commission.No..� � YG1 x i_
EXplrfs: iverilaar 16, 2021'-
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i drtdod thni Moron i%otary,
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REVIEWS_
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA Tf RTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW'
REVIEW
QATE
RECEIVED
DATE
i
COMPLETED
nuv '/ may,