HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED I D V l -
Date: Permit Number: VJ
Building Permit Application
Planning and Development Services
Building and Code Regulation Aivislon
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: �1 77n Ut:,,(;�k-
Legal Description: �r
Property Tax ID#. "7J )Q-0005-00* tot No.�^
Site Plan Name: Block No.
Project Name: ���
Setbacks Front Back: Right Side: Left Side:
ti nal war o e e rme under is permit–c ec a appy:
HVAC Gas Tank Deas Piping _Shutters Q Windows/Doors
Electric Q Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of ConstrKtion:$ 1 0 — Utilities: Sewer OSeptic Building Height:
Name. Name:
Address; Company: (r'B r (`
City: State: Addres
Zip Code: Fax Z `� City: SWe
r. p ,772 3a q) '9 7�
Phone No. �n'�> 1 1 Zi Code: Fax
�,4.1a,�'lf �aO CCJ5J,()e
Phone No.
Fill in fe mple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or C my License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: — Phone Zip: Phone:
FEE SIMPLE TITLE MOLDER: Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Addres.�: Address:
City: City:
Zip: Phone: Zip: Phone:
OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permit to do the work and Installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
St.Lucl_,;ucatl maks$nc
representation that is granting a permit will authorize the permit holder to build the subject strkicture
which is in conflict�rwit i 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 permit applications are exempt from undergoing a full concurrency review:room additions,
accessory strLictures,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 twke 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
cvmmencin work or " cording your Notice of Commencement.
Si;Ngr!
o O er/lessee/Contractor as Agent for Owner Si/ Contractor/License Holder
SF FL0R3D N SyATE OF FLORID I
C OF — iU`� COUNTY OF ��1eff t-
was t rgcing i;�stru t nt{was acknowledged before me The forgoing instru e was acknowledged before me
this day of 20- by this-day of 201�?by
Name of person aking statement Name of person aking statement
Personally Known OR Produced Identification Personally Known ✓✓ OR Produced Identification
Type of identification Type of Identification
ProducedProduced
-—^ MAIGs A.GRO SMIANCRAIG A.GR
My COMMISSION FF99MO2 y� _":L6*�
MY COMMISSOMN
� --� i , 020
(Signature of Notary Public-State. Fa�+a.Mca ry , gnatu a of Notary Public-State i �s
Commission No. (Seal) Commission No. (Seal)
--T
REVIFWS FRONT ZDNING SUPLRViSGR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIE74 REVIEW REVIEW REVIEW REVIEW REVIEW
DATE --
RECEIVED
DATE
COMPLETED
Rev.8/2/17