HomeMy WebLinkAbout24030475 APPLICATION FOR BUILDING PERMIT CERTIFICATE OF CAPACITY-ZONING`-�� ���f�FG
SLCCDV Form No.: 001-02 j
CERTIFICATION:
OWNER INFORMATION:
This application is hereby made to obtain a permit to do the work and installations as indicated, and to obtain a certificate of
NAME: -TATES A bQENOA K , b / izm SE b capacity, if applicable, for the permitted work. I certify that no work or installation has commenced prior to the issuance of a permit
ADDRESS: °�I 40q S � . bpgsNO2E `mzene.� S r l e�}2i �L- '3gQg1-1 and -that -all- will be -performed to -meet the -standards -of -all -laws regulating-construction-in-this-jurisdietion. I understand that
separate permits may be required for ELECTRICAL, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS,
CITY: STATE: ZIP 30. TANKS, AND AIR CONDITIONERS, ETC., not'otherwise included with this building permit application.
PHONE (DAYTIME): UZ6 257- 5101 The following building permit applications are exempt from undergoing a full concurrency review: room additions, accessory
IF THE FEE SIMPLE TITLEHOLDER (PROPERTY OWNER) IS DIFFERENT FROM THE OWNER LISTED ABOVE, PLEASE FILL IN NAME AND ADDRESS structures (all types), swimming pools, fences, walls, signs, screen rooms, utility substations & accessory uses to another non -
BELOW. residential use.
FEE SIMPLE TITLEHOLDER: 0l % A
NOTICE TO OWNER: FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING
ADDRESS: TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN
FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING
CITY: STATE: ZIP YOUR NOTICE OF COMMENCEMENT.
PHONE (DAYTIME): ( 1
NOTICE TO APPLICANT: AS THE APPLICANT FOR THIS BUILDING PERMIT, IF IT IS NOT YOUR RIGHT, TITLE, AND
INTEREST THAT IS SUBJECT TO ATTACHMENT; AS A CONDITION OF THIS PERMIT YOU
CONTRACTOR INFORMATION PROMISE IN GOOD FAITH TO DELIVER A COPY OF THE ATTACHED CONSTRUCTION LIEN
2 //
3/b LAW NOTICE TO THE PERSON WHOSE PROPERTY IS SUBJECT TO ATTACHMENT.
ST. of FL REG./CERT #: L: Ise � - 0 ST. LUCIE COUNTY CERT #: � t O' i
BUSINESS NAME: �i%gf�`S �� �! �" �b �OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance
QUALIFIERS NAME: �Y�""� (iU 11�l9 �� f with all applicable laws regulating construction and zoning.
ADDRESS:
CITY: STATE: �� ZIP OWNER/CONTRA
pR SIGNATURE N RACTOR IGNA URE
PHONE (DAYTIME): (j) E6 5 � 1��V FAX NO.
STATE OF FLORIDA STATE OF F D
COUNTY OF COUNTY OF
ARCHIT/ENGINEER:
The foregoing in�rument was acknowledged The foregoing instrument was acknowle ged
ADDRESS: before me th' 10f day of 20� b day ofMArCn, 20�, y
y _ before me is L b
CITY: STATE: ZIP ' is personally known to me or who ITV K_j Ii1iww , who is Dersonally known to me
has produced as identification. ho has'produced as identification.
PHONE (DAYTIME):
S'gnature of Notary ignature of Notary
BONDING COMPANY: ; n
ADDRESS: �r � 1 1"T n`� lv'
' Type or Print Name of Notary Type of Print Name of Notary
CITY: STATE: ZIP
Not is Title3uanita F. Dunn
s •MY OMMISSION# DD074405 EXPIRES Notary Public Title
Y ,, rrF De ember 18, 2005
missi vil 11 NINSURANU INC Commission Number
MORTGAGE LENDER: CA&ftMAAmokf
ADDRESS: (seal) (seal) MYCornrMasionDD07S887
a ExPirss December 2, 2005
CITY: STATE: ZIP
NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACH SIGNATURE MUST BE NOTARIZED.
IMPORTANT NOTICE: When a permit is issued and it is not picked up within 60 days IF APPLYING FOR THIS BUILDING PERMIT AS AN OWNER/BUILDER, THE OWNER MUST PERSONALLY APPEAR
TO SIGN THIS APPLICATION IN THE OFFICE LISTED ON THE FRONT OF THIS APPLICATION.
after notification it will be voided and returned to you by mail.