HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
H I'V
Building Permit Application DEC 0 5 2017
Planning and Development Services
Building and Code Regulation Division 13=13NIITTING
.2300 Virginia Avenue,Fort Pierce FL 34982 St. Lucie Ce:' t,: FL
Phone:(772)462-1553 Fax: (772)462-1578 Commercial Residential V
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
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Address:
Legal Description;
va dna CI a+ l(oC_ c,'_?>O (.off
Property Tax ID#: Lot No.
Site Plan Name: I
Block No.-J�
Project Name: &&YU
Setbacks Front Back: Right Side: Left Slde:
IN Him NOWNENNOWNWO.-
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4w 14
z. S40 Kco-�-�
iUoa workto e rme under this permit-check a appy:
Hr'AC 11 Gas Tank ❑Gas Piping _Shutters E]Windows/Doors
Electric El Plumbing Sprinklers El Caenerator Roof Roof pitch
Total Sq. Ft of Construction: r Sq. Ft.of First Floor:
Cost of Construction:$ ( Ca Utilities: Sewer Septic Building Height:
Name('-�,Clj-L) CQWJa2it Name: . V,
Address: 1 11, ry14r0l�L( aA Company: Iqf' !{
City: a Iter State:8z_ Address:
Zip Code: �M(V Fax:_7��� �- ��} City: Stater
Phone No.-'Z`7 11'7Z� Zip Coder Fax:-7
E-Mail: Qc2291'an Oat@ c Phone No. "Tz- - S
Fill in fee(sjimple Title Holder on next page(if different E-Mail: �d i
from the Owner listed above) State o ounty License:
If value of construction Is$2500 or more,a RECORDED Notice of Commencement is required.
L
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 str cture
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 Horne 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 twine 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
commencingiwork or wording your Notice of Commencement.
Z/ /
Sign 0 0 er Lessee/Contractor as Agent for Owner Si f Contractor/License Holder
ST C1F FLORI �►TE OF FLOR
C NTY OF_ COUNTY OF �(�1�1�_
-The fo�r�ggoing instrument was acknowledged before me The Wing instru ent was cknowledged before me
this� day of U�Ce 'L CAC. 201' by this day of e � 2012 by
Name ofper�so9 making statement Name of perso aking statement
Personally Known_.5[ _OR Produced Identification Personally Known nOR Produced Identification
Type of Identification Type of Identification
Produced Produced
�7 qq�� _ CRAIG A.ORO S11iIlAN CRAIG A.GR MAN
V ✓.1�*A^�-- MY COMMISSION FF990902 /a '�' •'= MY COMMISSION
1 , 41 1 2G
(Signature of Notary Public-State49 L Fflpgallo4 l nate of Notary Public-State c f. F1rY/NNr
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW I REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17