HomeMy WebLinkAboutScanned DocumentsALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
COCJIV`I"Y �
Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
1300 Virginia Avenue, Fort pierce FL 34981
Phone: (772) 462-1553 Fax: (772) 462-1578
Commercial Residential /1'3—
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line Mw,
PROPOSED IMPROVEMENT LOCATION:
Address: k O Z -V W i LQ- LA
J _
Legal Description: IVr a
Property Tax ID #: c�iDZ - OC)1, - OC)oLot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back
Right Side: Left Side:
lnsw\ocilc w\ av (�a may" 1; 3
CONSTRUCTION INFORMATION:
Tdclitional work to be Ferformea un er this permit - check all that appy:
HVAC Gas Tank EGas Piping Shutters ❑ Windows/Doors
Electric ❑ Plumbing Sprinklers Generator ❑ Roof Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $ ,A . '-AOh , DC)
SFt. of First Floor:
Utilities:11Sewer E Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name LaYYSJ Chin iC S1" S13Y1
Name: JAMES F GRIMES
Address: — l 2 C)Cf c- kA-
Company: GRIMES !HEATING AND AIR CONDITIONING
City: _ Pk: - P i eX(-e State: 'FL
Zip Code: y q _ _ Fax:
Phone No. -1 �l 'Z �-i-�Q i7 -d5� 5
E -Mail:
Address: 3054 N US HWY 1
City. FORT PIERCE State: FL
Zip Code: 34846 Fax: 772-461-8722
Phone No. 772-461-8711
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E -Mail: KAYLAGRIMESAC@AOL.COM
State or County License: RA0018071
If value of construction is >tbuu or more, a RtCURDED Notice of Commencement is required.
I certify that no work or installation has commenced prior to the issuance of a permit
wh ch Is inoconflicmt makes
anrepresentation leI a Owners tAssgociatlon rules bylaws or and�covenantss that build
ay restrsubject
ct o 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 pians, 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
commencing work or recording vour Notice of Commencement.
ature of Owner/Lessee/Contractor as Agent for Owner
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF Ste. Lt(' COUNTY OF ST_ L_UC_ 4
The forgoing Instrument was acknowledged before me J The forgoing Instrument was acknowledged before me
this _M day of Nt)kt . 20 4�by I this12- day of J L>V 20 by
-,_ AN E-1-1 F 69_krnL� J 3nn�Ls -i::
(Name �
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public- State of Florid`"
Personally Known OR Produced Identificatfon
Type of Identification roduced
Commission
Notary Public- State of
Personally Known OR Produced Identification
Type of Identifica n Produced
Commission No. (Seal)
MY COMMISSIONgGG089099 11 1
";; SUSAN MONTENEGRO
Revised 07/ x° n11� NOwr Putic under nLm COMMISSION # GG 0
F EXPIRES: April 2.202189099
a; Boded TM Notary P,.hir i m
REVIEWS
Not Applicable
MORTGAGE COMPANY:
P"` Not Applicable
Address:
REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
Name:
7
r
City,
COMPLETE
Address:
Zip' Phone:
State:
City:
State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Not Applicable
BONDING COMPANY:Not
74 Applicable
Address;
Name.
City:
Address:
City:
ZIP: Phone:
Zip: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit
wh ch Is inoconflicmt makes
anrepresentation leI a Owners tAssgociatlon rules bylaws or and�covenantss that build
ay restrsubject
ct o 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 pians, 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
commencing work or recording vour Notice of Commencement.
ature of Owner/Lessee/Contractor as Agent for Owner
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF Ste. Lt(' COUNTY OF ST_ L_UC_ 4
The forgoing Instrument was acknowledged before me J The forgoing Instrument was acknowledged before me
this _M day of Nt)kt . 20 4�by I this12- day of J L>V 20 by
-,_ AN E-1-1 F 69_krnL� J 3nn�Ls -i::
(Name �
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public- State of Florid`"
Personally Known OR Produced Identificatfon
Type of Identification roduced
Commission
Notary Public- State of
Personally Known OR Produced Identification
Type of Identifica n Produced
Commission No. (Seal)
MY COMMISSIONgGG089099 11 1
";; SUSAN MONTENEGRO
Revised 07/ x° n11� NOwr Putic under nLm COMMISSION # GG 0
F EXPIRES: April 2.202189099
a; Boded TM Notary P,.hir i m
REVIEWS
FRONT
ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER
REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
1