HomeMy WebLinkAboutGrimes App AN APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
Cuau
Building Permit Application
Pbnning and Development Services J
Buiiding and Code Regulation Division Commercial Residential J�
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578
PERMIT APPLICATION FOR:
Address: S60c1
Property Tax ID#: 24 Ll9— q�3 ----n(S3—CXSU-3 Lot No.
Site Plan Name: %ki ��� Block No.
Project Name:
ETAILED DESCRIPTION OF WORK:
v1 c I n - r of o
Y ' n �.
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit-check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors _Pond
_Electric _Plumbing _Sprinklers _Generator Roof ' Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor: 2�f
Cost of Construction: $ �D�CSUL7 Utilities: _Sewer _Septic Building Height:
WNER%LESSEE: CONTRACTOR:
SCA(1 t ���(\'(�/l�P Name: floricto -rQio %(f Id P) end \
Name SU
Address: � 6 V G Y� Company:-T �{
City: State: Address: lJu
Zip Code: L Fax: City:, ( State:_
Phone No. 0 . 0 Zip Code: -�')2:94K1 Fax:
E-Mail: Phone No a'
Fill in fee simple Title Holder on next page(if different E-Mail Q C
from the owner listed above) State or County License (P
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
If value of HAVC is$7,500 or more,a RECORDED Notice of Commencement is required.
ENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY:
Name: t Applicable
Address: Name:
City: Address:
Zip: State: City: State:
Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: _ of Applicable
Name: 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, 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 paying twice for
improvements to your property. A Notice of Commencement must be recorded in the public records of St.
Lucie County 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 our Notice of Commencement.
Signature of Owne see/Contractor as Agent for Owner
STATE OF FLORIDA,
COUNTY OF �11(I(� �r
Swo*Vday r affir d a d ab#cribed bet0A me of Physical Presence or Online Notarization
this of t` 20_ by
AA
M i p IGs —
Name of person m king statement.
Personally Known OR Produced Identification
Typ f Identificati n Produced
(Sign ture f o ary Public-State of Florida)
C-1C1 �1 YP� ANALI M.VIEYRA
mmissio
Con No. (Seal) '' °# MY COMMISSION#GG907977
EXPIRES:August27,2023 a
Bonded Thru Notary Public Undernglters
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
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