HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO//MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: lb Permit Number: %aG 6 is CR,
RECEIVED APR 082016
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERM IT APPLICATION FOR:
Address: 300 r,,.�y1rl?� v,
e
Legal Description:
Property Tax ID#:_/ 3�.' O 00 ! 0o - _ Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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Additional Work to be per-tormed under this permit-c ee a tamtappy:
_Mechanical _Gas Tank Gas Piping _Shutters "Wind ows/DoDrs
Electric Plumbing _Sprinklers _Generator Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ 560 . 00 Utilities: _Sewer _Septic Building Height:
ir'�-=�WT. •a``�
QVII ER�L ESS EI� � � — CO,TTR�LTO
Name Name: `i .nS' �Dt^�Sd✓�
Address: dd� �)iti�.�:'�� Q,n2� Company: Chr-'S o ktr- Ato
City: El Pref G e, State: Address: 1701 S• 11 }h .�71
Zip Code: ?`1 ,) IU — Fax: City: F�. F.-ef - State: F I
Phone Not-7-7 Z2.34 -I P� l Zip Code: 3L1."'AL41 Fax:
E-Mail: Phone N -7
Fill in fee simple Title Holder on next page ( if different E-Mail
from the Owner listed above) ' State or County License �- "1 O�
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE 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.
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 jobs'te
before the first inspection. If you intend to obtain financing, consult with lender or an attorney befor
commencing work or recording our N of Commencement.
Si ure of Owner/Agent/Lessee tractor signature ontractor/License.Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF Sk, 1.-.x COUNTY OF Sit • �-yc��
The fgoing instrument as acknowledged before me The f rgoing instrumen was acknowledged before me
this day of 20 by this day of 20 r by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary P blit-State of Florida ) (Signature of Notary Pu c-State of Florida )
Personally Known OR Produce �`aa Personally Knowr _OR Produced Identifica o ��^
Type of Identification �EPNNP SNNe��6.2� Type of Identification , D NpGIVE—fi d
Produced °`a ,a\01' `yes 5a�6 Pss°. Produced � � Pob��o_Stat stake 2 E
�aY Y PUG jeQ
16,Commission No.� aP ° ':MYNa"p 'Commission No. � •°MY hcou9h National Cyolary ss
4,�, _ 1i, , °ic 5�<<'edT�r� 's''%'�<.,�e;•' 0.onded 6. 1
REVIEWS FRO N` I ZONING SUPERVISOR PLANS VEGETATION A TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE .
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RECEIVED
DATE
COMPLETED
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