HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED •RAPP [ON • E ACCE T •
Date: C Permit Number. q1z--o0V '
J RECEIVEM
Building Permit Application
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Planning and Develop
04 2019ment services
Building and code ReguMan Division
ST. Lucie County,Permitting V1
2300 Virginia Avenue,Fort Pierce FL 34982
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Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential
ILPERIMIT APP'LICATION FOR: To Select from dropbox, click arrow at the end of line
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Legal Description:
Property Tax ID#: -1 L&-000 H Lot No.
Site Plan Name- Block No.
Project Name:
Setbacks Front_ Back: Right Side. Left Side:
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t al'Worktb�b-L-nertorFn—a----d-rtfiwI permix-c e Ayi,
HVAC Gas Tank Gas Piping Shutters Windows/Doors
Electric Plumbing OSprinklers Generator Roof Roof pitch
Total Sq.Ft of Construction: So.Ft.of First Floor:
Cost of Construction:$ -q'fnrit c")- utilities:OSewer Septic Building Height:
—2 V 119 Al (TA
#718 kit
Add ressA 0 'A
City: Ft. 4�-Ival State:
Zip C�de: D Fax.1
Phone No.--77
FIJI In fee4simple Title Holder on next page(if different
from the Owner listed above)
if Valuo.of cc�;iir�on ls'�2-500 or more—,a R—ECOR.'DED Notice of Commencement Is required,
12/04/2019 10:51AM 7723989727 GROSSMAN PAGE 03
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: Narne:
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 Coun makes no representation that is granting a permit will authorize the permit holder 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 orkor cording your Notice of Commencement,
Sign of erl Lessee/Contractoras Agent for Owner Si6f contractor/License icense Holder
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ST OF FLORID ATE OF FLORIDA_4.t,0 .,
C NTY OF 1A lov COUNTY OF
.The f, Ing instrument wars_acknowledged before me The f ins instrument was icknowledsed before me
Tr
this Tday ofVCeM2Z._ 26liby. this day of
Name of pers*making statement Name of person making statement
Personally Known OR Produced identification Personally Known 4 OR Produced Identification
Type of Identification Type of Identification
Produced Produced.
CRAIG A.ORO OSMAN 'CRAIG A.G MAN
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MY COMMSSION 90,
0*' MY COMMISSION*FROW02
F P#qEqS44W1 atu e of Notary Public-State c 20
(Signature of Notary Public-State
Commission No. (Seal) Commission No. (Seal)
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S
N
20
REVIEWS FRONT ZONING SUPERVISOR PLANS V156ETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
LQQMPLETED
Rev.8/2/17