HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED •
Date; I)- 7— /g Permit Number: [ fij I-- 010)
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Building Permit Application
Planning and Development Services
Building and Cade Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential
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PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
Address I IAJ f - . -
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Legal Description: I . g /j/. '_ rf IA , / A
Property Tax ID#: ./ ' ' fi 0 1-000 -1 LotSite Plan Name: ti _ - Block No.
Project Name:Za
Setbacks Front Back: _Right Side; Left Side:
40- L 1 i► - r —si �I96-4,1-71 - A ergs
14 6 - JO 40h �
•--``ona wor a • orme• unser is perm ...c ec a i•. appy:
rw/HVAC Gas Tank LIGas Piping III Shutters U Windows/Doors
Electric !Plumbing Sprinklers D Generator D Roof Li I Ruof pitch
Total Sq.Ft of Construction:
C S Ft.of First Floor:
Cost of Construction:$ f J Z/, • Utilities: Sewer Li Septic Building Height:
Name 601121./. • , / • Name: i a•;11 /t J
Address: 1 i'. Compan /� • 2
JA r 1 )' r
City: C1■lltin,- State:J Address: _q x'.1 .� 'IL.„,e'
Zip Code: Lf t(o Fax:•77Z;q j'? City: .. State:
Phone No, Zip Code: % Fax:7 7Z7-39 8-990'7
E-Mail: � �
( ‘(lri(,{�lY iceccJ'Y!(.'f� inef Phone N0.17Z R r �
Fill in fee imple Title Holder on next page(if different E-Mail: cj . S t1'iGif'i6�G7 q �'L�YYi ri)-at-
from the Owner listed above) State or d unty License: -.C-I s-g o qj
if value of construction+s$2500 or more,a RECORDED Notice of Commencement is required.
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DESIGNE• ENGINEER: _Not Applicable. MORTGAGE COMPANY; Not Applicable
Name: - _ . Name: _
Address: Address;
City: . State; City: _. . State: ,I
Zip: _ Phone Zip: Phone: II
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: _Not Applicable
Name: Name: • _
Address: Address: I
City; City:
Zip: Phone: Zip: Phone:
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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 representation that Is granting a permit will authorize 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,l 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
.commencin ork or -cording your Notice of Commencement.
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i��e AdST�Y L iL 4,'.-
Sign:'ff7'0.0 'er Lessee/contractor as Agent for Owner Si:•-17791.• Contractor/License Holder
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ST• •F FLORIDA. , ' TE OF FLORI
C sf NTY OF c_r•12.1 a COUNTY OF • eA' -
The forgoing instrument w s acknowledged before me The for oing instrument was acknowledge efore me
this (,p day of DVQ{i r e ,201(6 by this le day of ti hle lM bt ,20,1T by
Name of pers making statement Name of perso►yrnaking statement
Personally Known OR Produced Identification - Personally Known U OR Produced Identification
Type of Identification Type of Identification
Produced__ Produced
CRAIG A.GROSSMAN ' CRAIG At GRC${liMAN
i:'. 'i MY COMMISSION#FF990902 it . Ai MY COMMISSION*F 290$0;
l'z'pi: EXPIRES May 10. �' '~ ` -. . 10.;020
(Signature of Notary Public-State ., ,t..,:513R� gnatu-e of Notary Public-State of ,i,•nuc -.
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 m
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