HomeMy WebLinkAboutBuilding 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 ,V/
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of bine
Address:
Legal Description:
Property Tax ID #: , i� L
Site Plan Name: II
Project Name: _ _t
Setbacks Front Back:
-02ao-000-1
Right Side: Left Side:
Lot No.
Block No.
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Company:/ tI—
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Address:i ar �?/ t,+
L? h -e&4 --e
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aVAC
e e orme un
Gas Tank
er this perm — check a appy;
❑Gas Piping — Shutters
Windows/Doors
Electric
E] Plumbing
Sprinklers 0 Generator
a Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
j ,
Cost of Construction: $ Utilities:Sewer r Septic Building Height:
Address:�(U) U
City: 1, 't, V+, C
Zip Code:. 5- Fax
Phone No.
E -Mail: rr.T l.,�j"j2_dahl'jl" c�
Fill in feesimple Title Holder on
from the Owner listed above)
-7 7Z
page ( if different
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
Name: + . � , U" i n
_
Company:/ tI—
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Address:i ar �?/ t,+
City: �� (— tate: FL
_
Zip Code: `7 Fax: � 72-",3t,
Phone No. ':7-77 ---341 - 010 2,
E -Mail:
State or C' unty License: 0 PW ► � q 2
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
` r-J1wF'rn/t1N1UI dtkK: _ Not Applicable -
Name:
Address:
City: State:
Zip= Phone
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City: State:
Zip: _________ Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY:
Name: — _.__Not Applicable
Address: Name:
City: Address:
Zip: Phone: 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 nttooy work or installation has commenced prior to the issuance of a permit.
Which is inoconflicmt with any representation that
OwnersAssocil permit u esabylaws or and covenants that maydrestrictborproh bit 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
commencin ork or_ cordin our Notice of Commencement.
A r
s� uruvvnery Lessee/Contractor as Agent for Owner
ST OF FLORID'
C NTY OF - �I 1�._
The for oing instrument was acknowledged before me
this day of 20A by
Contractor/License H
DATE OF FLORID
COUNTY OF
The for oing instru nt was acknowledged before me
this day of LL-� 20_L3 by
Name of person making statement Name of person 'making statement
Personally Known .� OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
CRAIG A. GR OMAN CRAIG A. GRI
='t MY COMMISSION FF990902,R�► t
'•: MY COMMISSION
(Signature of Notary Public- StateI t'RRES MW
g 'gnatu a of Notary Public- State
Commission No. (Seal)
REVIEWS FRONT ZONING
COUNTER REVIEW
DATE -
RECEIVED
COMPLETED
Rev. 8/2/17
Commission No.
(Seal)
SUPERVISORI PLANS IVEGETATION �SEATURTLE MANGROVE
REVIEW I REVIEW REVIEW REVIEW I REVIEW