HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
Ste. - �� ;�•�� � -
_____ ____ ___ _ _ _
Building Permit Applicatio EEE
Planning and Development Services
Building and Code Regulation Division OCT 3 0 2017
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax: (772)462-1578 , Commercial esidenti .n' lent
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PERMIT APPLICATION FOR: To Select from dropbox, click arrow at t eb6' ' 1e ou
nLY
PROPOSED IMPROVEMENT LOCATION: p.
Address:S5b Su_nse - B�V d \ iC rCr d-L.. .'I�$ o�
Legal Description: Indian River Estates Unit 8 Block 59 Lot 8
Property Tax ID#': 340260902660004 Lot No.8
Site Plan Name: Block No. 59
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED'DESCRIPTION OF WORK:
Demolition -(==
CONSTRUCTION INFORMATION:
Additional work to _ e e orme under this permit-check a y:
app
HVAC F]Gas Tank Gas Piping _Shutters Q Windows/Doors
Electric ❑ Plumbing . Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: SFt.of First Floor:
Cost of Construction:$- (��Oa Utilities: _Sewer Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name C-Mery 1 C,ac on Name: 7olnv► —4.
Address: 'T661D S U_V1,S k4_ RA%JC.. Company: Groza Builders, Inc.
City: State:FL Address: 511 SW Par-- S{ . Luck B,fud.
Zip Code: 34982 Fax: City: pot-4-s+' L uc i G State:FL
Phone No. Zip Code: 34953 Fax: 772-336-2272
E-Mail: Phone No. 772-336-7653
Fill in fee simple Title Holder on next page(if different E-Mail: Tony@grozabuilders.com
from the Owner listed above) State or County License: CGC1524734
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN,LAW INFORMATION-
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _L,1466Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: mot Applicable BONDING COMPANY: __L—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 thepermit 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 recording our Notice of Commencement.
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Signa re of Owner/Lessee/Contdactor as Ag t for Owner Sig ture of Contractor/License o er
STATE OF FLORIDA STATE OF FLORID
COUNTY OF � ►.
-L� U-Q' COUNTY OF �• LCin
The forgoing instrument was acknowleq&q before me The f r oing instr me t was ac<nowledg�efore me
this day of (Z'xb1CW_C 2 by this day of 20 by
_A . C�tr_o_ o_ ,Tnon A. Gmza-
Name of paking statement Name of perso aking statement
erson
Personally Known �OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Signature N ta,,s; lic-StatAN ' t�i�LEY (Signature Notary Public-Stat Florida)
6..ULM'S MY COMMISSIG�1 FF936804 1V0' � a°N
Commission No :' lJe l/ Commission No. 611,0Z'
Commission
• ES November 17,2019 Y089£6�J#NOISSI6N6NOO
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407)398-0153 MrWaN rvice. .,
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319N
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COM P LETED
Rev.8/2/17