HomeMy WebLinkAboutBuilding Permit Applicationx000iona/xvorunu unoernno o cnecxax UM oppiy:
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Total Sq. Ft of of First Floor: —
If value ofconstruction is $2500ormore, aRECORDED Notice ofCommencement isrequired.
Building Height:
N
—g7
City: Q.A
State:
Addr�es-Cf4f)o
Zip Code:
Phone No.
Zip Cod
E -Mail:
Phone
E'K8oU:
Fill infee simple Title Holder mnnext page (if different
from the Owner listed above)
State or Cou nty ricense: L
If value ofconstruction is $2500ormore, aRECORDED Notice ofCommencement isrequired.
Building Height:
N
DESIGNER/ENGINEER:
_ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Signature s e/Agent
Name:
Address:
Ff
STATE OF FLORIDA
COUNTY OF
Address:
City:
State:
City: State:
Zip: Phone:
V h 0
Zip: Phone:
(Na a)Tper on acknowle f rrg)
FEE SIMPLE TITLE BOLDER:
_ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
Personally Known �y OR Produced Identification
Address:
City:
Type of Identification P or`duced
City:
Zip: Phone:
n PR;Y p�R� siiEls e7 SCHWAB
p
N ,ry iir. State of Florida [�
Zip: Phone:
I certify that no work or installation has commenced prior to the issuance 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 on the jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or rc-9--ording nur Notice of Commencement.
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Signature s e/Agent
Signature of Cori r Li ense Holder
_
STATEF FOR
Ff
STATE OF FLORIDA
COUNTY OF
COU OF
COUNTER
The forg ing instrument was a knowledg before me
this day of ' -qlm 20by
The fr oing inst ent was ac nowledged before me
this day of 20 y
d
L111)
V h 0
REVIEW
(Na a)Tper on acknowle f rrg)
(Na e o ii e on acknowle gin
i
(Signature of Notary P,ub(ic- State of Florida)
(Signature of Notary Publicr State of Florida )
Personally Known �y OR Produced Identification
Personally Known A" OR. Produced Identification
Type of Identification Produced
Type of Identification P or`duced
Commission No. fi eat)
Commission No, �Seai)
n PR;Y p�R� siiEls e7 SCHWAB
p
N ,ry iir. State of Florida [�
ti , ..
SF( ;LiSS SCHWAB
l 3' 6 i � 11Soi t FF 205427
Revised 07/15/2014 N,; 'CO Mr1l. E),pifeQ, Nlrn. a, 201 ' ,i u'a x'j k/FF 20549-7-
My (rfn���,. Expiresi��i3r 3. 2019
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
INITIALS
FILE # 4166353 'OR BOOK 3843 PAGE 966, Recorded 03/07/2016 at :4
Mar. 3. 2016 11,OOAM . NETTLES ISLAND INC No 2$.16 ` -P, 2
02126/Z016' 711.21. mHORE RUUNNU VAP AW I (FAX)...
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Che undcrsigacd hcrolff gi,Vcn n+ tide that i�rprowrm will br, made to certain rod propaq, and in adcordanco'with Chhplor 712, ,. .
PloAda Wtutes the folPowfng 3rtfolr6otiq?t isprovided in thi N6tio* of ootnmencemenK
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2. I�x9NERAI;DESCl�TION OF WPRtJ[11t,11=NT,. �+%' ® Colt
3.4D'1' 1t. URUAa1'ION1 • a. Name ° �' ,��
b. M&M a 1 �q initrestin property
d, Name and address of foo simplo dtloholder (if' oTli" dlaa owriet)
4. CONT dACTORIS rl.&-.Yt ; ADDRESS AND PROM MMMURt
5, $URETY'S NAMY,, ADDRESS AND MQN9M11d]3ER AND BOND AlV.LC)UgT:
5. =1 MV -18 NAM9, ADD=S AND PHONE, NCJM)MI
7. Persong within tho Stat* of Vlorida designated by oxvnor upon whom nofices or othcs documents may bo served as provided by
Section
713.13 (1)(0) T., noyyddga� S�tolu�tpe�ss:fig®
i./ili. , ADDRESS AND PHONE NUMBEIL-
3. In addition to himself ox>herseM owner designates tho following to rccaf'Vo p oopy of tho Lionor'a Notico as provided in SeetloA
'713.13 (1)(b), Florida Statutes!
YVAM%A,UDAM AND PROM NUWlrlt:
9. BxpiraEion. datt of nafice. dcowmencoment: (the expiration date is I yycar from tbo data ofrecording unless a different dot* is
specified) _ , 2
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d)Tvner's An%oilked �ilicot/]05reetgx/P�rhier/ilforrsger tl r'G�u ' "_" Notary puhtfc - State of Fiortda'
Commission r FF205427
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Stalo ofFto da
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The mgoinS nstromaifwr<9 atkrY9wledged beforeme this - day' of 2OIL
(Name of person) (Type of authodtp•,.®.g, Qwner, officer, Erustee, attoropyinfact)
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oma ofpariy on last df hornhstnimentwas o'er, od) tis ontrlly'i%n0W o pr ated tbo following type off:
(1'rattSd I�fame QPz�QtaLy puhlit) (Signatrrab of Notazy Pohlio} t;�eat1} z a COE
Ujider paxWties of pedu:ty, X declara that I hava read the foregoing and that tlat faols in it are true to the best of my laiowiedge. an oc,i
bellet'(sectioo 32.545, Flodda Statutes). z i
Slgtrat-, n(s) oP Owner(sj or Oivner(s)' Authorized t: Mcer1DjrecforfPadnur/M noge$-wbo signed ahoyet 4�`� °'�oF I
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