HomeMy WebLinkAboutPierorazo Mario AC Changeout permit applicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
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: r
n
Legal Description: I IlIf,
Property Tax ID #: 2�1- `�
Site Plan Name:
Project Name: Ie ni rAZ
Setbacks Front Back: Right Side: Left Side:
ri�0aarle-
? �l5-�v� I�}sE�-10KW
Lot No. I
Block No. 5,21
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Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $ Aw-0 Utilities:] Sewer E]Septic Building Height:
Name:
city: Vora � I✓-- State Address: 052D
Zip Cod Fax: -I- 6 Z 0"' `; City: 1
Phone No. '��� _ Zip Code:
E-Mail: 0' olatincicc7 Ls � Phone No.
Fill in simple Title Holder on next page ( if different E-Mail: f
from the Owner listed above) State or ilountv License:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
UNW9�' Rffil"►)�
State:
Fax:% %Z 2 zj f t��
NGINEER: _ Not Applica
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone
MORTGAGE COMPANY:
Name:
Address:
City: -
Zip: Phone:.
Not Applicable
State:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
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 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, 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 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
commencingAnrork or Wcording your Notice of Commencement. ,—
Lessee/Contractor as Agent for Owner
Contractor/License Holder
FLORIDAj STATE OF FLORIDA
OF - ('( COUNTY OF • �I( 2
The fg oing instr ment was acknowledged before me
this day of It • 20t'll by
V,
Name of perso making statement
Personally Known OR Produced Identification
Type of Identification
Produced
The ing instrument was acknowledged before me
thisforgoday of� L 264 by
Y Ci�D ry Im
Name df permaking statement
Personally Known soOR Produced Identification
Type of Identification
Produced
" • CRA1G A. GROSSMAN
':►""i'',•' CRAIG A. GM:%�• ?:
�_`: "; My COMMISSION
FF990902
MY COMMISSION
(Signature of Notary Public- State QWs gnatu a of Notary Public- State
I r
Commission No.
(Seal)
Commission No.
(Seal)
REVIEWS
FRONT ZONING SUPERVISOR
COUNTER REVIEW REVIEW
PLANS VEGETATION
REVIEW
REVIEW.
SEA TURTLE MANGROVE
REVIEW REVIEW
DATE
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RECEIVED
DATE
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COMPLETED
Rev. 8/2/17
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