HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
RECEIVED
Building Permit ApplicationAPR 2 7 2018
Planning and Development Services
Building and Code Regulation Division ST. Luuc County, P rmltting
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
Address: I iipp f e�
Legal Description:
Property Tax ID M. b04190_000--R Lot No.
Site Plan Name: 1)'t xp- Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
AC 5twcro
10 KLd h ecc4
i nalworko e performedunder is perm t—c ec a appy:
HVAC Gas Tank pGas Piping OGenerator
Shutters a Windows/Doors
Electric Plumbing O Sprinklers Roof Roof pitch
Total Sq.Ft of Construction: Sq.
5 .Ft.of First Floor:
Cost of Construction:$ / o Utilities:Sewer El Septic Building Height:
NameName: o
Address: L10 Q� Company:
City: State: Address: ISA (Sifille- r
Zip Code: Fax: ' City: Stater
Phone No. _7?7Zip Code: Fax:J7Z-3q!8 _997
E-Mail: Phone No.
FIII in fee simple Title Holder on next page If different E-Mail: 69
from the Owner listed above) State or County License: (^�' 6_z0g
If value of construction Is$2500 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.
St.Lucie County makes no represent tion that is granting a permit will authorize the permit holde to build the sub)ect structure
which is In conflict with any applicable Home Owners Association rules,bylaws or and covenants tfat 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
commencingiwork or mcording your Notice of Commencement.
Sign . o OvAer7 Lessee/Contractor as Agent for Owner 5i7TE
f Contractor/License Holder
ST OF FLORID FLORIDA
C NTY OF ' .L{'i6-c COUNTY OF c . Ulu-e_
The forrg�oing Instrument was acknowledged before me The r oing instrgMent was acknowledged before me
this��l day of A:12r,� 20�by this day of F+D-1 ( 20,�by
Name of persorymaking statement Name of person making statement
Personally Known ti/ OR Produced Identification Personally Known �_OR Produced Identification
Type of Identification Type of Identification
Produced Produced
2_ . CRAIG A.OR $MAN CRAIG A.GRIS MANi MY COMMISSION FF99M '- MY COMMI3S101rl A 90901
(Signature of Notary Public-State. } ' gnatu a of Notary Public-State t ' 02EI
Frrwtl.r Servs 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