HomeMy WebLinkAboutGrassi permit appALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date
Permit Number:
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
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address
Legal Description: 3q &S N- V IMM ' boa` i
oh il - eok
Property Tax ID #: Lot No.
Site Plan Name: Block No.
Project Name: bl si
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Sh"nlk 4_93�'
312 I�Ch
CONSTRUCTION INFORMATION:
I1� Js' s&.
INI) Go
-%,fv.0
Jditional work to be
HVAC
11 Electric
CONTRACTOR:
ertormed under this permit — checK all n apply:
Gas Tank []Gas Piping Shutters
Plumbing Sprinklers Generator
❑
Total Sq. Ft of Construction: p
Cost of Construction: $ *114
SFt. of First Floor: _
Utilities:cn Sewer []Septic
❑ Windows/Doors
Roof Roof pitch
1
Building Height: V3
OWNER/LESSEE:
CONTRACTOR:
Name W
Name:
Address: ��a� nm] Dwak LN
Company:
Q
City:A_ '�- Luca State:
Zip Code: Fax:
Phone No.9-la- q05;- SIS -1
Address:
t 1 'b(•
City: MplouraState:-IL
Zip Code: Q
Phone No.L "QM 'Vigil
Fax: �jl� 0.2' 1 17 3
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E -Mail: -�IyOVD RUIiQS�
State or County License: C�
•,��Mmyf oy1
(�227c���S
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applica
Name:
Address:_
City:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name: _
Address:
City:
Zip:
Phone:
State:
_ Not Applicable
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY:
Name:
Address:
City:_
Zip: _ Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
— Not Applicable
State:
Not Applicable
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, coA with lender or an attorney before
commencing work or recording your Notice of Commencem9nj7/1
Signature of Owner/Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
this _ day of , 20 _by
(Name of person acknowledging )
(Signature of Notary Public- State of Florida )
Personally Known OR Produced Identification
Type of Identification Produced
Commission No,
Reviscd 07/15/2014
(Seal)
Contractor/License Holder
STATE OF FL IDA
COUNTY OF a(VA
The forgoing instr ment as acknowledge before me
this � day of 20 rr by
1,16)" Art-,
(N me of lierson acknowledging )
(Signature df NoTary Public- State of Florida )
Personally Know OR Produced Identification
Type of Identification Produced
AW N P
Commission No. r�tiMJIISSIONMFF99M
RES: June 1, 2020
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