HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 1 Date: 0 (i 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
PROPOSED IMPROVEMENT LOCATION:
Address: g-7 JAS 1�511IC,^t,� �{S l)r--,t' ��p(��j ( 3 S I
51 Legal Description: tvli51n 1�JVVOub,
Property Tax ID #:
Site Plan Name: _
Project Name: _
Setbacks Front
Back: Right Side: Left Side:
Lot No.
Block No.
DETAILED DESCRIPTION OF WORK:
Li (ce, 1w16_Wi new C-TOJM0.0 4 +Otl 1 Set(_ -�tc[ca�e unlit
WiA,h to Kw meat
CONSTRUCTION INFORMATION: I((
hIHVAC L 1 Gas Tank (JGas
[]Electric Plumbing OSpr
Total Sq. Ft of Construction:
Cost of Construction: S 400,00
nn-cneEX all appry:
Piping _ Shutters
nklers ❑ Generator
_ S Ft. of First Floor: _
Utilities: Sewer 0 Septic
QWindows/Doors
E]Roof
Building Height:
OWNERAESSEE:
CONTRACTOR: -
Name per,+ bw4tr
Name:
Rlcmd
Address: i
Company: r oI In
r
City: Rt �b(Ii 1R6State:
Zip Code: Fax:
Phone No.
Address: SIA A Ti xn pi1(Q
-
City: �{{ Rp fr(p. State: Ki
Zip Code: 3LJq fj 1 Fax:77a- I-R& S7 37
Phone No.71)-- qu 1 -0 +1
E-Mail:
Fill in fee simple Title Holder on next page) If different
from the Owner listed above)
E-Mail:
6�00���/(Q� A it[f/). �Y✓I
State or Cou4y License: OXfX I I�
If value of construction is $2500 or more, a RECORDED Notice of
required.
SUPPLEMENTAL CONSTRUCTION LIEF! LAW
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 that
or and covenants may restrict or prohibit such
structure. Please consult wt'dr 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
commencingwork or recordingour Notice of Commencement_
Rev.8/2/T7
#Is�F£)��1t(ATFQ�i:
DESiGMfit�fNGlNEfR:
Name:
_ Not Applicable
MORTGAGE CC}E'�SPAi�Y:
Name:
_ Not Applicable
Address:
Address:
City:
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIlyfi�tE TITLE i#f3LiBER:
Name-
_ Not Applicable
BONDING COMPANY:
_Nat Applicable
Signature o#Owner/ esseefConiractor s ent rOwrser
Signature o#Contractor/License Holder
STATE OF FLORIDA
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STATE OF FLORIDA
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COUNTY OF
COl3NTYOF
The forgoing instrument was acknovuierlged before me
The faT�oing ins nt was acknowledged before me
this [9F day of tJ u [ t�
20 (q by
this [ S T day of� fA�
. 201� by
r �aJOVIC,
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Name of perso9��naking state t
Name of perso
making statement
Personally Known V
OR Produced Identification
Fersonaliy Known
ORProduced identification
Type of identification
Type of Identification
Produced
Produced
6
y
(Signature of NotarComm
Fc- State of Honda j
{Signature of Notary Pub! -State of Florida l
Cammi55ia
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Commis n.v">"•••,
CHRISTINE J. CONyI�t,�"
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Notary Public- State of FWrida
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Notary a m State o o i a
Commission # GG 017839
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Commission # GG D77839
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