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Building Permit Applicatioll! 7
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Code�qqulutionr
.i •.Avenue,Fort
Phon 772)462-1553 Fax:(772)462-1578 Commercial Residential V/
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Property'=ID#: W1511- r r Iirr .
ProjectSite Plan ame: Block No.
Setback� -Front Back, Right Side: Left Side.
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e-j— rtorm.ec1 Lincler this permit check a-111hat apply---
4 ■ Gas Tank Das Piping ■Shutters OW!ndows/Doors
Elo�pic Plumbi ng Sprinklers Gene rator Roof
Sq. of Construct-ion: 5 Ft of First FIQDri
�r ■Sewer ■
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DESIGN R,/ENGINEER: Not Applicable MORTGJNGE COMPANY: Not Applicable
Name• Name:
Address. Address:
City: State: City: State:
Zip. s s Phone: _--- Zip:: Phone:
FEE SIM ' E'TITLE MOLDER: Not Applicable BONDING COMPANY: _Not Applicable
Name: I Name:
Address—,"l— Address:
City: i City:
Zip: I . Phone: Zip: Phone:
II '
I certify tFn t no work or installation has commenced prior to the issuance of a permit.
St.Lucientt��rr makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in onflict with any applicable Homeowners Assoclation rules,.bylaws or and covenants that may restrict or prohibit such
structure. ease consult%wth your Home Owners Association and review your deed for any restrictions which may apply.
In considei Ation of the granting of this requested permit,I do hereby agree that I will,in all respects,perform the work
in adcorda iLe with the approved plans,the Florida Building Codes and St.Lucie County Amendments.
The follow r g building permit applications are exemptfrom undergoing a full concurrencyreview:room additions,
accessoryructures,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use
WARNIN d OWNER;Your failure to Record a Notice of Cornmencdment may result in your paying twice for
improvei ents to yourproperty.A Notice of Commencement must be recorded and posted•on the jobsite
before t first inspection. If you intend to obtain financing, consult with fender or an attorney before
com men n work or record ing your.,Notice of Commencement.
I
Signature f owner/Agen Lessee Signature of Contractor/License IRolder
STATEO �FLORIDA' �nary STATE OF FLORIDA
COUN i F_ COUNTY OF
The ins ' s acknowledged fore me -The oing ins e t s a owledged before me
this d y of 20 by this ay of 20, by
ro Qcu -Hal I. n-0 '11
(Name of iS I n ackn Wledgi ) (Name of person acknowled Ing)
iYoi( 02CL6�� ._
(5ignaturi f NotaryPublio-5 e Florida) (Signature of Notary Pubic t4A of Florida)
Personally own � OR Produced Identification Personally Know /
n ✓ OR Produced Identification
'Type of Id •tification Produced Type of•identification Produced
Commissi o Lt5eal); Commisslon N eal
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iGRY$7At.MARIE CRu7AD
Revise •I 7/15/2014 Ma'BZ+unr9*10 g expipaS June 25.2016
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REVIEW FRONT NS VEGETATION SEA TURTLE MANGROVE
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COUNTER REVIEW REVIEW REVIEW RMEW REVIEW REVIEW
DATE iJ
COMPL
INITIALS � I .
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