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
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
Address: _3 (f f't) (�,',1"ivv��(��G'I �tlKbV1QQ
Legal Description s�,yl.l_1 I_I_Ia ub —'RQ+ Wo
Property Tax ID #: WE,—oLN —01) Lot No.
Site Plan Name: ' 'W �n i cL Block No.
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Project Name: ftyio lil.1L
Setbacks Front Back: Right Side: Left Side:
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�I�C1lUr� -3,5 An I45EEC- �7�5K 11�ea�
LEI Electric ❑ Plumbing Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ _3. D _
Named (trYI t 6 c? (-i/Ur1(1
Address: C I C{ MY
City: 't' State:
Zip Code: Fax:77Z'3906 -q
Phone No_.'T)2-3
E-Mail:�rl?�i1�C(f1i'1l)C/uiG�l'Ylr�:
U Shutters
Generator
S Ft. of First Floor: _
UtilitiestSewer Septic
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name:
Windows/Doors
Roof Roof pitch
Building Height:
Company (/)V) Hi K rd7h i'v
Address:,
City: P 4y Stater
Zip Code: Fax!—IJ7J510:: �
Phone No. —I
E-Mail:
State or Co my License: _6q
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER ENGINEER: _ Not Applicable
Name:
Address:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: _Not Applicable
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, 1 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 or rl!cording your Notice of Commencement.
,j
Signa ,u Wof'0 �er/ Lessee/Contractor as Agent for Owner
Si af Contractor/License Holder
ST -OF FLORIDA
COUNTY OF 131. W L e
STATE OF FLORIDA
COUNTY OF �4, q
The forgoing instrument was acknowledged before me
this _J2-day of WI1dLcj'1 202 �' by
The forgoing instrument was acknowledged before me
this � day of VI1 &I d i 20 7�' by
Name of per!7making statement
Personally Known ✓/ OR Produced Identification
Type of Identification
Name of persQrr making statement
Personally Known OR Produced Identification
Type of Identification
Produced
Produced
rr
:+ CRAIG A. GROSSMAN
9 �� : MY COMMISSION
o. •
(Signature of Notary Public- State A FlatidallotaryS� .
CRAIG A. GRC
FF990902 n =' •: MY COMMISSION
S
S
C
EXPIRES May
Jjgnatu a of Notary Public- State tW •A3 Florldallola ,
Commission No. (Seal)
Commission No. (Seal)
REVIEWS
FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR
REVIEW
PLANSFVEGETATION:SEA
REVIEWEVIEW
TURTLE
MANGROVE
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17
MAN
S090;
120