HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: \`-A
Building Permit Application
Planning and Development Services
Building and Code Regulation Vivision
2300 Virginia Avenue,Fort Pierce FL 94982
Phone-(772)'462-1553 Fax-(772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Selectfromdmpbo-x, click arrow at the and of line
Address: o,,5,7 inu pr.
Legal Description: 8gli
Property Tax(D#: Lot No.
Site Plan Name- Block No.
Project Name:—
Setbacks Front Back; Right Side: Left Side:
N I
W
VOVIVA ral to _Iaf 0 M,160,A t- W/2 I
_
I
CW rle___ 3,15
T low
t a work to b_ELP. rmecl undertnis permit—check all apply.
HVAC Gas Tank FGas Piping —Shutters OWindows/Doors
Electric Plumbing []Sprinklers 0 Generator Roof Roof pitch
Total Sq.Ft of Construction: Sa.Ft.of First Floor:
Cost of Construction: Utilities:0Sewer Septic Building Height:
Name H,A Name:ITf,±J_Lfe---V Gms's Y1
Address: M09 Wvwl rlV-0— Company: Gr V7)1
r7
City: State-.FIZ Address: r51,4h V;vo-M em EY
Zip Code: FaxJ- 1 Z-32ii :9�'Z7 CltT
Phone No:i zip Code:)de: Fax:
Phone No.--j"72-31
Fill in fe impte Title Holder on next page(if different E-Mail:
IN n C
,140
from the Owner listed above) State or calinty License:.LuffA
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: blame.
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 Count�yy makes no representation that is granting a permit will authorize the permit holds to build the subject structure
which is in confllet 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,I do hereby agree that i will,in ail respects,perform the work
in accordance with the approved plans,the Florida Building Godes 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 financini,consult with lender or an attorney before
commencingtworkorpecordingypur Notice of Commencement.
Y�v 49�� Yi
Sign, o OViAQF1 Lessee/Contractor as Agent for Owner S f Contractor/license Holder
r'
ST F FLORIDA ATE OF FI.ORtD
NTY OF � COUNTY OF ' &( G!
,The fqrgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of Mf L(h .204 by this. day of �d L Coq ,as by
Name of pe making statement Name of Osteo aking statement
Personally Known _. OR Produced identification Personally Known_ OR Produced Identification
Type of Identification Type of identification
Produced Produced
CRAIG A.GROSSMAN CFtAlO A.GRC S AN
MY COMMISSIONII FP990NO2 , L : MY COMMISSION BM02
8 May
(Signature of Notary Public-State; F gnata of Notary Public-State 4 . 020
u
Commission No. (Seal) Commission No. (Seat)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
BATE
COMPLETED
Rev.8/2/17