HomeMy WebLinkAboutBuilding Permit Application AFF APPLICABLE INFO MIDST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: a 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 t/
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of linea a
Legal Description:
Property Tax ID#: 5Q!"' yG Lot No.
Site Plan Name: I"" Block No.
ProJect Name:
Setbacks Front Back: Right Side: Left Side.
(Cep(at (k�e (( (� Sid oil (aj f�GZL+
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i na wor o e e rme un er is permit—check aP@0)y:
HVAC Gas Tank Gas Piping _Shutters ❑Windows/Doors
11Electric ❑ Plumbing Sprinklers E Generator ❑Roof Roof pitch
Total Sq. Ft of Construction: SFt. of First Floor:
Cost of Construction:$ • Utilities: Sewer❑septic Building Height:
Name lr r Name: a�S
Address: I Company:
City: State: Address: r
Zip Code: Fax: "IY_,� City: tate:
Phone No. f Zip CodeFax:
E-Mail: 1? Phone NOT-11zr
Fill in fe simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or unty License:NIIM12 Q)
_ I
If value of construction Is$2500 or more,a RECORDED Notice of Commencement is required.
"DESIGNERNGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable i
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone dip: Phone:
FEE SIMPLE TITLE HOLDER: ,Not Applicable . BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip; Phone:
I
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 Horne 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,1 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
commencing1work ding your Notice of Commencement.
n
5ignat , of OvAef7 Lessee/Contractor as Agent for Owner Sigh Contractor/License Holder
ST / bF FLORID
$ZATE OF FLORIDq►
C NTY OF_. bAoi Y' COUNTY OF, —7 - lil CI°L
I The for oing instrument was acknowledged before me The fo oing instru� ent was acknowledged before me
this day of FP J'^Unr20� by this May of Xl I a Y14 20J-�)by
I
Name of persorymaking statement Name of person making statement
Personally Known ✓ OR Produced Identification Personally Known _OR Produced Identification
Type of Identification Type of Identification
Produced Produced
GROSSMAN ? CRAIG A_GR 8 MAN
✓� �__ i': MY COMMISSI¢N FF990902 y� C"t
MY COMMISSION 0 99DSW
(Signature of Notary Public-State r t gnatu a of Notary Public--state c 9 C20
PMrMallti a m
Commission No. (Seal) Commission No. (seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17