HomeMy WebLinkAboutKnag Leslie AC replacement 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:
c
LJKartno� t
Legal Description:
Property Tax ID #: � �"� q— "J V �"I �l(� Lot No. 1 2
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
Se
Additie(nal work to be pe ormed un er t is permit — c ieck all 1= apply:
5HEl Shutters Q Windows/Doors
VAC Gas Tank Gas Piping _
Roof Roof pitch
11 Electric El Plumbing U Sprinklers Generator
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
/� t713
[]Sewer 0
Cost of Construction: $ "I Utilities: Septic Building Height:
NTRACTO
Name _ - Name: - a
Address: a �`� Company: r
City: U _ State: Address:
Zip Code: � Fax �Z'Rq� "9`21 City: ( Staten
Phone Now-72 �3� 3 `���Z,5� Zip Code: Fax: 7� U %Z�
E-Mail: , ► f Phone No. — Z
Fill in fe simple Title Holder on next page ( if different E-Mail:
2
from the Owner listed above) State or 60FUNty License:
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:
Name:
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 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
commencin twork or rfcording your Notice of Commencement.
Signa uc of O er/ Lessee/Contractor as Agent for Owner
Signa r f Contractor/License Holder
STM� OF FLORID i
SATE OF FLORIDA
COUNTY OF l �l e
COUNTY OF �-
The forgoing instrument was acknowledged before me
The forgoing instr�ent was acknowledged before me
this day of 1o11�P�'l � 20 C by
this r5 day of �1tCYL �ev 20JC by
.
Name of person making statement
Personally Known Z_ OR Produced Identification
Name of person making statement
Personally Known 1/ OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
CRAIG A. GROSSMAN
+' CRAIG A. GRC
S
Gq,(1. �: iti9Y COMMISSION
FF990902 » =� ': MY COMMISSION
(Signature of Notary Public- State (. li� FwdaN.taryS.
,
.agnatu a of Notary Public- State c fAWA3 FWftNofa
Commission No. (Seal)
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
_.
Rev. 8/2/17
IMAN
9W90;
'020