HomeMy WebLinkAboutBUILDING PERMIT APPLICATION-bl
ALLIPPLICABLE INFO MUST Of CMAPLETED FOR APPLICATION To BE
ACCEPTED
:20 SWM.US54 CANNED Permit Number.
BY
t. Lucia County
Building PerM!t Appikation
and0evelaMentSimko
and Code Region DW.Won
1. AmueFortPfwwa3MZ,,
M�W '(772)462-1553 Fax:(rn)462.1,5711
Plans ' �'"g and'o,
C
Oultid! 7, 11;d n�
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le
Commercial Residential
PER APPLICATION FOR: To Select from
dfOPbOx, click arrqw at the end offlne
7,
Addres U-t -9
190
Legal D -scription:
(rq- UN
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Site
- Yf
M
Tax ID M -4 o3 - M3Y- OW
Lot NO.
Name.- &sA a
ame: t I Block No.
Front jo Back: 0 Right Side: /0
Left Side:
Atl
Afto 0 F 3�_E.�L ri,(•Z
(2A.5
J GF-91AAMCA, a —Tiffe 0 F *r (gA
144ATEko 4ZJ4f~T_ &AS 's
'Co IN
Addirk-n-
WOM to be pe
rme under th pmt-c
k a-- aPP y.
MAC Gas Tankasping
Shutters
Windows/Doors
Elk
c Plumbing Sprinklers
Generator
Roof Roof pitch
Total Sq.
I Of Construction:
Sq. Ft. of First Floor:
Cost Of
nstruction: $
Sewer -,,,-Septic
Building Height
WNE /f,FSa►EE.
Nam
A.
Address•
CT,
Name:
Companir.
fr-, I=& 6L
C17Y State: rc
Address:
Tip Coe i
a —Fax
City-, AL& C 11-1 Y.
StatF--- P-41
Phone'1116 603 - 149 S �-36' -
Zip Code: 2M_W0 Fax.•
1-Maik.Q
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&C& C- ISANAil" Q
'hone
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P No. I ��
ilftx2 /0)G7
RU in tee
-nde Holder on am page (if different
.
E-Mail: 7"iXte
f
train the!
listed above)
State or County License:
ffiralue of 16MEWUMon
C&ME 0
Is more, a RECORDED "ce of Commencement is required..
0111owm E
MORTGAGE COMPANY: Not Applicable
DESIG' ER/ENGINEER: — Not Applicable
Name
Name:
Address:
Address:
City: Stater
City: State:
Zip: Phone:
Zip: Phone:
FEE SI PLE TITLE HOLDER: _ Not Applicable.
BONDING COMPANY: Not Applicable
Name
Name:
Address:
Addr �5s:
City:
City: II
Zip: Phone:
Zip: I' Phone:
II
OWN R/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I• certi I' that no work or installation:has commenced prior to the issuance of a permit.
St. Luci Countymakes no representation that is granting a permit will authorize the permit holder to build the subject structure
which i in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such -
structu ' Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
lle.
In cons 'deration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
in accoii ance 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
WARP SING TO OWNER: Your failure to Record a Notice of Commencement may result in your paying twice for
impro' ements to your property. A Notice of Commencement must be recorded and posted on the jobsite
befor( the first inspection. If you intend to obtain financing, consult with lender or an attorney before
com 6ncing work or recording our Notice of Commencement.
by
i a ,ur •an rae License No er
STATE OF FLORID.. 1 II
STATE OF FLORIDA ,� L
CO U TY OF Ki'" l i��
COUNTY OF
The orng instrum n was acknowledg efore me
by
The forgoing instrumen w s acknowledge efore me
thist9b day of Uy.
thi day of 20,
j20T'by
T.
be�c 6r�
(Name
of person acknowledging)
Name of person acknowle m
( P g g)
I� r
(Signature
of Notary •ublic- State of Florida)
(Signature of Notary P lic- State of Florida )
Person;
IIy-Known.., OR Produced Identification
Personally Known L— OR Produced Identification
01111
Type o
i Identificatio
,��.. --
Type of Identification
�.
Commi
I �.�'v�y P"o��.
,� ^State of Florida -Notary Public
Sion No. 9• ' •= Commi�5eaijff GG 190282
���►un
�y¢•" ;,State o1 F rld -Notary Public
Commission No. ' CommUlA GG 190282
My Commission Expires
February 20, 2022
FRONT ZONING SUPERVISOR
'�,;��o My Commission Expires
February 26, 2022
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ev. 7),[014