HomeMy WebLinkAboutBuilding Permit ApplicationrA IT" e • , •• • e
Date: 17 ....Permit, Nurnbe
REC;ac-an TJ,.�a6' qc Q .any - _
t . D
Width g Perm it- Application
Planning and Development Services AUG /1 2017
Building .. Code Regulation Division
0. Virginia.34982
• Residential
APPLICATION FOR:
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Legal Description:
Property Tax I• r' ! Vo �_z - ex5a Lot No.
Site ' • No.:
Project
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Additional work to be pe
Mechanical GasTank Gas Piping • • , • •
Electric Plumbing Sprinklers• . • . •
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction- $ *)C>0C)'— Utilities: Sewer Septic Building Height:
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DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: Not Applicable
Name: SurJCoeRSi iAlulr,►+nlu+vt c-su!3uill
Name: S,ACrn - T �i i`io��r�-1 3A�
Address: 13630 -Of�- 5T, A(oz-rta Su+rE ioI
Address: AoP,lL:i 4'%ill
City: <�l e'Y'�R WAT&x.- State: fI
City: Eu i'5 4: State: 4f
Zip: 3 3 �_ a Phone: L� - s 3 Z 90�
Zip: 361 Z 6 Phone: - 3;SZ- 03 - 9 `ll
i
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name: i
Address:
Address:
City:
City:
T
Zip: Phone:
i
Zip: one:
OWNER/ CONTRACTOR AFFIDVIT:.Application,is hereby made to obtain a permit to do the work and in as indicated.
I cert+fyahat no work or installatioll commenced prior,to theissuance 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 bn the.jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencin work cLr_recording your Notice of Commencem
ignat Owne / A nt/ Lessee
Signature? Contractor/ +tense Holder
STATE OF FLORID
C
1
STATE OF FLORIl
COUNTY OF C'.
COUNTY OF
The forgoing instrument was -acknowledged before me
i
The forgoing instrument was acknowl.edgedi.before me
this - day of 20 by
this day of (� 20 by
i
(Name of person acknowledg+' g)
(Name of person acknowledging )
(Signature of Notary Public- §kgvbf_o—ricla)
(Signature of Notary Public- St t of Florida )
Personally Known OR Produced Identification
Personally Known OR Produced Identification
4du
Type of Identification Pr aced
Type of Identification ced
,, {{^^ 1*er .ftl A GOODMAN
Commission Ng� _( 1� ��� �°e '• `(S OMMISSION#FF10t341
�o�.,:;8��� BAR M A. GOODMAN
Commission No � RMISSION#FF101341
*
* * EXPIRES: Match 12, 2018
*
EXPIRES: Marcd 12, 2018
mr e�
BondedThmBudptNofaryServtces
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 7/2014