HomeMy WebLinkAboutBuilding Permit AffidavitAll APPLICABLE INFO MUST BE COMPLETEU'�OR APPLICATION TO BE ACCEPTED
Date: /D. 17, Permit Number: )%%c&
Description:Legal 0131 d .
Property Tax ID #:
Site Plan Name:
Project Name: _
Setbacks Front
•�� �_.` � � � r, do
Building Permit Application OCT 1 1 2017
r
Back: �— Right Side: /— Left Side: t—
Lot No._
Block No.
Additional work to be pertormed under tnis permit — cneCK an tnat appiy:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: Utilities: —Sewer —Septic Building Height:
t71NNER/l�ESSEE
CQ.NTRAGTOR:
—777,7
Name
Name: MOW A11110F,
Address:
Company:
�10�,�I1�i%�li
City: P'�1
Stater
Addr s: '
A �
Zip Code: Fa
City •, l�`i� � r wI —
Stated[_
Phone No.
Zip Code:
Fax:
E-Mail
! CL�
Phone No
E-Mail gr
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
State or County License�,,,��/%�e%
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
O� f-Q Irr3a
UPPLENIE�iTAL CC}NST �T"tQNsL1EW1�LAW tNFQRMATIO,U.
....h m _ �..
DESIGNER/ENGINEER: o Not Applicable MORTGAGE COMPANY: Not Applicable
Name: I C Name:
Address: G VAE gal Address:
City: state: City: State:
Zip: Phone Zip: Phone:
K LZ
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 jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording our Notice of Commencement.
i
Signature of wner/ Lessee/Contract r as Agent for Owner
Signature ofContractor/License Holder
STATE OF FLORI
TATE OF FLO A
COUNTY OF °(fir .-
OUNTY OF Y
The forgoing instrument before
was acknowledged m o
this day of P 20�by m
he forgoing instrum t was acknowledg d b, far;lrie IY
this day of 20�7 `
,
s z1oa
Q YK a
Q 1
mc�—n <
. 2 Gr p
Name of pers making statement. s
Name of perso making statement.
o
�
/OR
z'
Z3�v&
�OR
Personally Known Produced Identificatio n N +=1
Personally Known Produced Ide ffi
Type of Identification
Type of Identification oA
Produced
Produced �N
(Signature of Nota ublic- State of Florida)
(Signature of N ry Public- State of Flo ida)
Commission No. (Seal)
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.