HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: � \0 �5 Permit Number:
RECEI...
9 ,: o
:..�- ���: . . =. Atte 1
VOLSIX
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 here
a1 " ''ar '£L
#?Rd�►?QEDIPR4V ,E # T4CAT[ i , �� S
....U„ - .a..a:i,:.s.�S.-S.,�>xf .P,
Address:o '�
Legal Description: f��G�1� 0 pl+Qq/ O W
Property Tax ID#: �{ �} — — 0 0()) d (2 ^ d Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
� x
j(c 'y
CONSTI Il Y®It��iY�o�M l�l�
N n r g
Additional work to be nertormed under this permit—check all appy:
HVAC Gas Tank ❑Gas Piping _Shutters ❑.Windows/Doors
11 Electric 0 Plumbing Sprinklers Generator 13 Roof
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ 06 6 Utilities: _Sewer Septic Building Height:
40�Tf,1R.
Name 6UY Je JC �)_ t Name:
Address: 0 i' 1 (A- 5 IAL Company: 1 i 6t N6ze — C
City: l�j�Y�`� State: Address: S c7.
Zip Code: Fax: / City: �S �
State.
Phone No. —7 -; 9,5 `— /Y 7 L Zip Code: _� i 3 Fax:-1;7_2_2V—
E-Mail: Phone No. /d
Fill in fee simple Title Holder on next page(if different E-Mail: •Q 04('Q Q b
from the Owner listed above) State or County License: Q'c O 3
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
r H x '4 "=sw -a r r �.- �'" { •^P@'+" F '}-
rSUP�LEhIlE[�TAi. �t STRUCI�ICDl nL`t i I.A1A [N� RMAT6ClrN
<R, "1 >. ...-:xk s..��w�..r�. ?., fi if.A.i2� ^�a..�
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: s µ _Not Applicable .
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
I
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 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 our Notice of Commencement.
Signature of Owner/Agent/Lessee Signature of Contractor/License Holder
STATE OF FLOR14A STATE OF FLORIDA ,
COUNTY OF S'C L-U C COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me j
this �6 day ofQl%-d, 20by this\0 day of <!i� 20M by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Pub -State of Florida) (Signature of Notary Pu c-State of Florida)
I
Personally Known entifigat4dih IVENS rsonally Known , , ro uce ANpfiSPROD
Type of Identification Pro ced°a 1— y Public State 01 1 e of Identificati R' P A t Florida
My Comm.Expires EE 85876 -2' My Comm.Expires Dec 16,2016
Commission No. ���5 1 (SeC�b)nmission# sgp mission No. .� Comm0ei@4 EE 858761
Through National Notary ,,,F ��,,.
Bonded Bonded Through National Notary Assn.
Revised 07/15/2014 -
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED