HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 'ti \ \d Permit Number:_\A
RECEIVED
Building Permit Applica#io APR 2 4 x018
Planning and Development services
Building and Code Regulation Division ST. Lucie County Permitting
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 A1C
Address: 10 // // �11ty,�-eU�_
Legal Description: LA 6d )w M&
Property Tax ID C100_tp Lot No. <i� ,
Site Pian Name: Block No,
Project Name:
Setbacks Front Back: Right Side: Left Side:
hOYLt
i na wor to orme under this perms —check a app y:
HVAC Gas Tank ❑Gas Piping Shutters Windows/Doors
Electric Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction:
,� S . Ft.of First Floor:
Cost of Construction:$ "7`GfR UtilitiestSewer El5eptic Building Height:
Name /+� a1 f Name:
Address 0 � r Company: n r 6L *ux'
City: wh
State.P: Addre,§s•
Zip Code: Caty: C� Ly 6-f- State:
Phone No. Zip Code:
E-Mail: Phone No..--7'7',? N
Fill in feiYsimple Title Holder on next page(if different E-Mail: as6malyw
from the Owner listed above) State or unty License:
If value of construction Is$2500 or more,a RECORDED Notice of Commencement is required.
"DESIGNENGINEER: _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 a permit will authorize the permit holder to build the subject s ructure
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 Nome 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 5t.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
commencin ork or rocording your Notice of Commencement.
_ 1
Z
o Q er Lessee/Contractor as Agent for Owner Si i -
Contractor/License Holder
�?��01`FLORIDA SATE OF FLORIDA
COUNTY OF_. r-J- ib�e COUNTY OF �_I"('e-
The forgoing Instrument W s acknowledge before me Theo oing instr ent was acknowledge dbefore me
this�day of r 20�by this day of "'i"l 20 by
Name of pers n making statement Name of person making statement
Personally Known OR Produced Identification Personally Known "' OR Produced Identification
Type of Identification Type of identification
Produced Produced
CRAIG A.GRO SMAN CRAIG AO 8 MAN
: •' 'r: _ - '
.
kly CCrMMISSION PF990902 _ MY COMMISMN 99o9D:
} 4
020
(Signature of Notary Public-State. f�oaape+ou gnatu e of Notary Public-State , R
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.8/7/17