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
FVPE�RMITAPPLICATION FOR: To Select from dropbox, click arrow at the end of line
Address:
Legal Description:
Property Tax ID #: /301-L ` -0 'z- r7 q"6a ' Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
rill C
or to e e orme un er t is permit -c ec a appy�
Shutters ❑Windows/Doors
r
Gas Tank Gas Piping _
❑ Electric ❑ Plumbing ❑ Sprinklers ❑ Generator ❑ Roof Roof pitch
Total Sq. Ft of Construction: S of First Floor:
0-0 Utilities: Ft._ Sewer I] Septic Building Height:
5/
Cost of Construction: $ % .
Name Name: a
Address: Ood.�m� Company: !�S ( r Cit t°�
City: ��- State: '/ Address:15 � ' P� �#
c
Zip Code:, 5� Fax:�7Z�3�� "���� City: ( G State:/
/]7
Phone No. �i�L� �P%% 2.� Zip Code: Fax:7 Z 3qg %?2
E-Mail: /'TP Phone No.
Fill in fee.' imple Title Holder on next page ( if different E-Mail: LIVOS W0A 11�01COA,,i'1`e
from the Owner listed above) State or County License:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER:
_ Not Applicable MORTGAGE COMPANY:
— Not Applicable
Name:
Name:
Address:
Address:
State: City:
State:
City:
Zip; Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
_ Not Applicable BONDING COMPANY:
_Not Applicable
Name:
Name:
Address:
Address:
City:
Zip: Phone:
City:
Zip: Phone:
.....J..+k
--L, nnri installatinn ne indicated.
OWNER/ CONTRACTOR AFFIDVIT: Application is nereoy mane w VULa " G N=! •� �� - -
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie CounttffyylI makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which
ructure. with
w with Hlome Owners Association Associationrules,
review your daws eed for any restrictions which may applyhibit such
In consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
in accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in your paying twice for
improvements to your property. A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing/work r,rf!cording your Notice of Commencement
Lessee/Contractor as Agent for Owner
Contractor/License Holder
STWE OF FLORIDA STATE OF FLORIDA
CCKJNTY OF ��� L� a COUNTY OF CLQ Ci
The forgoing instrument was acknowledgjd before me The forgoing instrument was acknowledged before me
this day of F$ ��b'tt �J ��u 2(1C�I 7`
by this J day of E -e-12 r cl C��I , 262 by
Name of person)raking statement
Personally Known OR Produced Identification
Type of Identification
Produced -
Name of persory making statement
Personally Known \/ OR Produced Identification
Type of Identification
Produced
CRAIG A. GROSSMAN
N1Y COMMISSION FF990902 7�
(Signature of Notary Public- State � Fwna�Horay ., jgnatu a of Notary Public- State
Commission No. (Seal) Commission No.
REVIEWS FRONT ZONING
COUNTER I REVIEW
DATE
RECEIVED
COMPLETED
Rev. 8/2/17
CRAIG A. GRI
MY COMMISSION
(Seal)
SUPERVISOR I PLANS VEGETATION I SEA TURTLE MANGROVE
REVIEW I REVIEW REVIEW REVIEW REVIEW