HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST 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
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line v o
Address: n �� n7�
Legal Description: d- O4 hod( lz.t e(ki 9r
Property Tax Id#: qSL-"CJ— O� �n(1 Lot No_
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
HVa wor o-rme under is perm --c ec a appy:
AC Gas Tank Gas Piping _Shutters ❑Windows/Doors
11 Electric Plumbing O Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: S Ft. of First Floor:
:'a
Cost of Construction:$ Utilities: Sewer Septic Building Height:
Name Name: r
Address: C Company: 7! r( fimrral
City: �11SG�l� State: Addre
Zip Code: �� Fa X: ( M AY ----7"�J City: !
Phone No.7T-7 Z 1 _4 14, Zip Code: 62 - Fax: -77 Z
E-Mail: n1 '}tY- Phone No.
Fill in fee Imple Title Holder on next page(if different E-Mail: D��
from the owner listed above) State or Pounty License:
If value of construction is Woo or more,a RECORDED Notice of Commencement is required.
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.
5t.Lucie County makes no representation that is granting apermit will aut orize 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 permlt 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
commencin ork or ppcording your Notice of Commencement.
Signa of O er/Lessee/Contractor as Agent for Owner Sigel f Contractor/License Holder
ST bF FLORIDA,' r �y//ATE OF FLORIDA f'
COUNTY OF C 71 COUNTY OF LLQ o' e
The forgoing instrument was acknowledged before me The for oing instrument was acknowledged before me
this day of W 01-C6ri 20�by this day of 11�CCE'C ,2QA by
Name of person king statement Name of persyn making statement
Personally Known OR Produced Identification Personally Known -✓ OR Produced Identification
Type of Identification Type of Identification
Produced Produced
CFtA)G A. GROSSMAN " CRAIG A.GRC 8#111111"
_ '; My COMMISSION PF9W902 MY COMMISSION
G�- EXPIRES May13, oto
(Signature of Notary Public-State yb F „y��, gnatu a of Notary Public-State I
AlrftMlM1
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