HomeMy WebLinkAboutBuilding Permit ApplicaitonALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date
CC3
U T Y
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 V Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
ANT LOCATION: —
,.aP_
Address:
Legal Description
�4. WcI
1 3
I
Property Tax ID #: [ �� - �"(JVQ -bOQ - ¢� Lot No.
1
Site Plan Name:
Project Name: H I Kn -
Setbacks Front Back: Right Side: Left Side:
Block No.
u� �� — W C. �L s-fems all three1 q Is ( T h Mtr'( far 1&4 -ov?<
:1) ' nrn L- ,r 2f-on 14.5 ,S 7-ez c5K CO henfel-- a,nl -(1 rrlaidaire. 2� [
Electric
0 Plumbing
F]Sprinklers
L _j Shutters
FiGenerator
Windows/Doors
ElRoof
Roof pitch
Total Sq. Ft of Construction: S . Ft. of First Floor:
Cost of Construction: $ I Yam, 3
Utilities: _Sewer ❑Septic Building Height:
` CONTRACTOR:
Name Name-
Address: [ r Company: P y: r (
City: State] Address:
Zip Code: Fax: 7� ;��``� City:
Stater
Phone No �]�% '3� Z Zip Code: Fax.-
E-Mail: Phone No. -
Fill in fe simple Title Holder on next page ( if different E-Mail: a11 ''i"
from the Owner listed above) oe
I State or ounty License: G- f)t;cb q
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required
Name:_
Address:
City: —
Zip:
R: _ Not Applicable
State:
one
MORTGAGE COMPANY
Name:
Address:
City:
Zip: __ Phone:
— Not Applicable
State:
FEE SIMPLE TITLE HOLDER: — Not Applicable BONDING —COMPANY:
Not Applicable
Address: Name:
City:
Address:
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 %work or recording our Notice of Commencement.
n
of Owner/ Lessee/Contractor as Agent for Owner
STATt OF FLORID►�
COUNTY OF_ �f . N I _It
The f doing instru -Merit was acknowledged before me
this day of �9 % 20 by
Signa ydbf Contractor/License Holder
FATE OF FLORIDA
COUNTY OF_ LLtc
The forgoing instrumenj was cknowledged before me
thi day of f'k 201 q by
Name of person making statement Name of persor�+naking statement
Personally Known _� OR Produced Identification Personally Known ✓ OR Produced Identification
Type of Identification
Produced Type of Identification
Produced
CRAIG A. GRIFF990902
SMAN
'"" CRAIG A. OR,
�+:
U
h9Y COMMISSION
�l,
=' 'MY COMMISSION
-
(Signature of Notary Public- State
fiarkfallohrySery
i%
gnatu e of Notar Public- State
Y
FFj 11
(4f1 ,153
Commission No.
(Seal)
PbrldalloterySs�
Commission No. (Seal)
REVIEWS FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR
PLANS VEGETATION SEA TURTLE MANGROVE
DATE
REVIEW
REVIEW REVIEW REVIEW REVIEW
RECEIVED
COMPLETED
Rev. 8/2/17