HomeMy WebLinkAboutBuilding Permit Application qto -Qyal
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date " 1 ` /4/5 Permit Number:_ 16m"0.61
RECEIVE®
Building Permit Application 2016
Planning and DevelopmentServlces SEP —9
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax:(772)462-1578 Commercial X Residential
PERMIT APPLICATION FOR'- To Select from dropbox, click arrow at the end of line
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Address:
Legal Description:
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Property Tax 1D#: I. G k4— 6'0" \U�M 1 u b 1 Lot No.
Site Plan Name: Block No.
Project Name: CXP .{f. „_..•..,...._.�
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Total Sq. Ft of Construction: Sq. Ft,of First Floor:_
Cost of Construction:',$ Utilities:[]Sewer L]Septic Building Height:
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Name Name:
Address: Company: ;C e
City: M /tA4 Sto Address:_ (� ��, _16,e,e C
Zip Code: 3434 Fax: City: (2,vt Stater
Phone No-2 D^ q5 r 7600 Zip Code:. a-A Fax:44?_M_ Ci
E-Mail: Phone No.
Fill in fee simple"title Holder on next page(if different E-Mail: P5 dr HtA.,i,'I -C C3rs-ti
from the owner listed above) State or County License: EDC ISQQS.32�i
If value of Construction is$2500 or more,a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER. Not Applicable MORTGAGE COMIpANY. Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
EEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: 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 theermit holder to build the subject structure
which is in conflict with any applicable Home owners Association rules,bylaws or ang covenants that may restrict or prohibit such
structure.Please corisult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit,l 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,,swlm ,fences,walls,signs,screen rooms and accessory us to another non-residential use
WARNING TO O1N R:Your fa ure to Record a Notice of Commence ht may r ult in your plying twice for
improvements to our prope .A Noti a of Commencement m be record and posted on the jobsite
before the first i spection, If ou int d to obtain financing,co suit with len er or a ttorney before
comment!! w rk or recur ' r Notice of Comrrlencemen
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Signature of Owneri,Le /Agent Signature of Contr or/License Halder
STATE OF FLORIDA STATE OF FL RIDA
COUNTY OF hCOUNTY OF, _ VA
The for oing Instrument was acknowledge before me The forgoing instru en was acknowledged before me
this, day of 207 by this1_1 day of T, 20 J,(r—by
1c e"
(Name of person ackn edging) (Name of person ack iowle Ing)
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(Signature of Notary public-5 of Florida) (Signature of Nota Publi tae o€Florida)
Personally Known; j"' OR Produ d d nt'fic t Personally Known OR Produced identification
Type of Identification Prod rMe of Identification Produce
Comrniasion s Fr 817'18 �^ b+•:; ALEXANDER E. JAN$
Commission No. fe0l�mmission Expires mmission No. C+ ='• s �Q($6f,misslon p FF 6177
air, ' tvty Commission Expire
,p+,r.��r October 10, 2017 a%rS
f. ,.• .,,a,ynA� October 10, 201 7
Remised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS