HomeMy WebLinkAboutBuilding Permit Application 10-30-18;05:00 ;From: To:7724621578 ;7724618722 # 2/ 5
ALL.APPUCABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED (�
Permit Number. �oo
oftERECEVE7DI
Building Permit Application
Planning and Development Services 12CBuilding and Code Regulation oivision2300 Virginia Avenue,✓:ort Pierce FL 34982 nty, Permittinq I
Phone:(772)462-1553 Fax:(772)462-1578 Commercial ��_• R sidenxi—(-
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
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Address: 2• >r
Legal Description: -�) 14 U L
PA 0 F
Property Tax ID M.-i8 - - PP02 -0 qz)0- Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front_ Back- Right Side: Left Side:
:D1wTA1CI_D'DESCRIPTION"n
lY- sta a�a\ n cm a-b ki
':CONSTRUCr10N:JNFORMATION:
:
A00monal W9 rK to 0 r orme Under this permit_Ch eck a app y:
HVAC Gas Tank ❑Gas Piping _ Shutters []Windows/Doors
OElectric ElPlumbing ❑Sprinklers ❑Generator Roof Roof pitch
Total Sq.Ft of Construction: Sq.Ft.of First Floor;
Cost of Construction:$ �J{'1 rJ� (�O Utilities:0Sewer OSeptic Building height:
::OWNER/LESSEE:;::; ....;..: .; ;-':CONTRACTOR:
Name nA(rt {u&C bcl& kac l am g Name: JAMES F GRIMES
Address: i 1) C:,a Company*.GRIMES'HEATiNO AND AIRiCONDITIONING
_
City: fm +(,s Q '� O tyi S .,lr _-____State:l`_.� N Address: 3054 US HWY 1
Zip Code: ?��,�i t 1 Fax: City: FORT PIERCE State FL
Phone No. -7-12--gtzk- na4l0-I Zip Code: 34946 Fax. 772461-8722
E-Mail. Phone No, 772-461-8711
Fill in fee simple Title Halder on next page(if different E-Mail: KAYLAGRIMESAC(,,'7a AOL.COM
from the Owner listed above) State or County License: RA001$071
{f value of construction is SMO or more,a RECORDED Notice of Commencement is required.
10-30-18;05.:00 ;From: To:7724621578 ;7724618722 # 3/ 5
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DESIGNEE; ENGINEER. Not Applicable MORTGAGE COMPANY: 74 Not Applicable
Name: Name:
Address: Address:
City: States._ _____ City: State:
Zip ___ _..._..Phone: Zip; Phone:
FEE SiMPLE TITLE HOLDER: 4 Not Applicable BONDING COMPANY: Not Applicable
Name: Name,,
Address: Address:
City: City:
Zip: Zip: Phone:
I certify that no work or Installation has commenced prior to the I5suanGe of a permit.
which I$InConflictt with o representation that Is granting a permit will authorize the permit holder to buil the sub)ece structure
an
Vy ppllcable Hama Owners Assoc anon rules,bylaws yr anrq�covenants that may restrict or prohibit Such
structure.please consult wit 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 faliure 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
commencing work or recording our Notice of Commencement.
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ature of Owner lessQ7Contractor as Agent for Owner 5 ature of contractor License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTYOF nj t L► COUNTY OF
The forgoing instrument was acknowledged before me The forgoing Instrument was acknowledged before me
thls.�Lb day of_ iS b.9 V... 20%Kby this :�j day of 20_a_by
(Name of person acknowledging) (Name of person acknowledging) -
(signature of Notary Public-State of Horld (Signature of Notary Publlc.state of Florid
Personally Known_:�Sa OR Produced Identification_.._.._.___ .. Personally Known OR Produced Identification
Type of IdentificaClofS Produced type of IdentlflPro
catlo duced
Commission No. �" SUSA �ITENEGRO Cammission.Np.� (Seal)
MY COMMMION N GG 089099
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Boded rive Nomry Pu*Un"Vx lm
Revised 07/1
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
W COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS ����• --_