HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: -
Permit Number: 'I L
Property Tax lD#:
Site Plan Name:
Project Name:
Setbacks Front Back:
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Right Side: Left Side:
Lot No.
Block No.
—Mechanical Gas Tank Gas Piping —,Shutters Windows/Doors
Electric Plumbing Sprinklers Generator Roof Pitch
Total Sq. Ft of C'onstructiom�l Sq. Ft..of First Floor:'
Cost,ot Construction: $ 60o o Utilities: —Sewer _Septic Building Height:
Name 0,1 VP-olC , ;NVYI /iV7(C-110
State: City.:; -194
Zip Code: W 99( Fax:
Phone No.
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Name:., irr eQ 4
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Addresis:,.4.�-.- w
City: 6a-(,ix State:
Zip Code: Fax:
Phone No
E-Mail &Fwe , ;2tt - ) V At/,
State or County License 6%o5g W3
f value of construction is 2500 or more. a RECORDED Notice of Commencement is reouired.
7,77 Mml
St PPCEME IT 1ltt� 111%iRU TIC I L EN �IO M "A 'IQN.
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DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEtSIIVIPLE 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.
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St. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
is
which 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.
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Signature of Owner/ Lessee/ ontractor as Agent for Owner
SI nature of Contractor/Licens order
STATE OF FLORIDA .
COUNTY OF L,l..
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STATE OF FLORIDA,;:zN 1
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COUNTY OF
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The forgoing instrument was acknowledged before me
The or_ing instrument was acknowledged before me
this _�ay of Q� ,nC(�, 20 by
this day of "CLA C4'\ , 20j-&- by
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(Name of person acknowledging)
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r
(Name of person acknowledging )
( gn ture of Notary Public -State of Florida)
(Sig atu of Notary Public- State of Florida )
Personally Known FOR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
tpR PUg KIMBERLEEASHLEY
of t, KIMBERLEEASHLEY
Commission No. + , MJSj@%"SS10NN,FF958838
MygOSSION#FF958838
Commission No. * s ' * E e'"
z EXPIRES: February 9, 2020
9 P* XPIRE : February 9, 2020
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REVIEWS
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SUPERVISOR
PLANS
VEGETATION
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MANGROVE
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REVIEW
REVIEW
REVIEW
REVIEW
REVLEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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