HomeMy WebLinkAboutBuilding PermitALL 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: 59 (,P 0
Legal Description:
Property Tax ID#:L "r5c)3'o1n�_ noo-
Site Plan Name:
Project Name: ram. rJ _
Setbacks Front Back: Right Side:
Left Side:
Lot No.
Block No.
�7C-
01\_hE(� ol �n I lip Sm-E SKIS h�.a�e�
r 1a1 wui R w qe errormea unaer tnis permit- check a
HVAC Gas Tank Gas Piping
Electric Plumbing RSprinklers
LEI Shutters Q Windows/Doors
1�jGenerator Q Roof Roof pitch
Total Sq. Ft of Construction: S . Ft. of First Floor: _
J
Cost of Construction: $ 54 C r) �i J Utilities: USewer a Septic
iodine Name:
Address: _ Company
City: n �1State: Address:
Zip Code: !� Fax:- 77773 - City:
Phone NoJ� Zip Code:
E-Mail: 6 lf. Phone No. —3
Fill in fee S'llinple Title Holder on next page ( if different E-Mail: CU
from the Owner listed above) State or Cdunty License:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required
Building Height:
Fax:
DESIGNER/ENGINEER: — Not Applicable
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY:
Name:
Address:
City:
ZIP: Phone:
— Not Applicable
State:
_Not Applicable
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
commencing/work orbcording your Notice of Commencement.
Lessee/Contractor as Agent for Owner
cense Holder
STqMF FLORID II',
C `,
COUNTY OF (,(Cr `e STATE OF COUNTY OF O ' _ C {
The for ing instr ment was acknowledged, before me The forgoing instrument was acknowledged before me
this day of- 20 1 ` / by this"_�T day of �� 20 by
Name of person ,"king statement
Personally Known _V OR Produced Identification
Type of Identification
Produced
Name of person making statement
Personally Known v' OR Produced Identification
Type of Identification
Produced
CRAIG A. GR $MAN
MY COMMISSION FF99ON2
(Signature of Notary Public- State '�5� t '
F gnatu a of Notary Public- State
Commission No. (Seal) Commission No.
REVIEWS I FRONT I ZONING
COUNTER REVIEW
E
VED
PLETED
Rev. 8/2/17
CRAIG A. GRI
MY COMMISSION
(Seal)
SUPERVISOR I PLANS VEGETATION I SEA TURTLE MANGROVE
REVIEW I REVIEW REVIEW REVIEW I REVIEW