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:
Legal Description:ymhish wi-es 111
Property Tax ID #KQ Cek iILI* 716 00QN3'�3C Lot No.
Site Plan Name: Block No.
Project Name:n("_((
Setbacks Front Back: Right Side: Left Side:
k Le f-�v Ot_ r'2T(d enffat v '(a&-0* am IiFOcwrze 3-�n 143,a -y— a46
11 Plumbing
Sprinklers
LJ Shutters
Generator
QWindows/Doors
11 Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ t &�15. Utilities: _ Sewer 1:1 Septic Building Height:
Name ^ S
Address: halo
VF
City: )-r StateF
Zip Code: z Fax 7 :3 l�� " 2 -�'
Phone N07 Z -j ; Z.
E -Mail: QAY- f)S'51'!YV 1r'WrCC C IC S . iiL
Fill in fee ample Title Holder on next page ( if different
from the Owner listed above)
Name: . (�►^�SSYYtC�1/'1
Company rV5511/tmn P-ir Pim C M
Address- Yl l f
City: - LO CIlle State:
Zip Code: Fax: -7 7 Z ---3q L-22 Z'I
Phone No.`1-7Z---?`j4 25-
E -Mail: S CGGi
State or ounty License: (1 051? 2-C11 67
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
UWNtK/ LUN I KAL-FUK 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
commencing/work or recording your Notice of Commencement. /,-,
Signa ure of 0 er/ Lessee/Contractor as Agent for Owner Sig aW , K6f Contractor/License Holder
STAT OF FLORIDASTATE OF FLORIDA
COUNTY OF � . 0J COUNTY OF
The fgfgoing instru ent was acknowledged before me
this h� day of 1^t 2016 by
Name of person aking statement
Personally Known OR Produced Identification
Type of Identification
Produced
The forgoing instr ent was acknowledge before me
this '`day of1?r^(� 20 � by
Name of person �J�king statement
Personally Known 7/ OR Produced Identification
Type of Identification
Produced
: '
CRAIG A. GROSSMAN
SUPERVISOR
DESIGNER/ENGINEER:
_ Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:_
FF990902EXPIRES
_
Name:
Address:
REVIEW
Address:
City:
State:
City: State:
Zip: Phone
_
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
— Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
Commission No.
Address:
City:
City:
Zip: Phone:
DATE
Zip: Phone:
UWNtK/ LUN I KAL-FUK 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
commencing/work or recording your Notice of Commencement. /,-,
Signa ure of 0 er/ Lessee/Contractor as Agent for Owner Sig aW , K6f Contractor/License Holder
STAT OF FLORIDASTATE OF FLORIDA
COUNTY OF � . 0J COUNTY OF
The fgfgoing instru ent was acknowledged before me
this h� day of 1^t 2016 by
Name of person aking statement
Personally Known OR Produced Identification
Type of Identification
Produced
The forgoing instr ent was acknowledge before me
this '`day of1?r^(� 20 � by
Name of person �J�king statement
Personally Known 7/ OR Produced Identification
Type of Identification
Produced
CRAIG A. GRi
MY COMMISSION
(Seal)
REVIEWS
: '
CRAIG A. GROSSMAN
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
:*, MY COMMISSION #
FF990902EXPIRES
/y n
✓�
REVIEW
REVIEW
May 1
,
REVIEW
(Signature of Notary Public- State
Ow
F&id N,t,yS,n+,.,lgnatu
a of Notary Public- State
Commission No.
(Seal)
Commission No.
CRAIG A. GRi
MY COMMISSION
(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