HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �o f
Date: 1012.( Permit Number:
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Building Permit Application
03/1I3J321
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
PERMITTYPE:
Address: 15(S( N. Hiah 1" A1.A(6LLi10 tnA6if0(+Picru, FL.
Property Tax ID #: �"� �'�y�— VV�.� �V� 2" Lot No.
Site Plan Name: Block No.
Project Name:
Name QCMA tigx bur Cmd0 SSM.
.Name:
Address: 83 Snn 2-01" �e..
Company: H C
City: &_i &-64-h State:FL
Zip Code: Z Fax: 72CCY"1, `l �U
Phone No. 5 L S ll
E-Mail: P� e �l (� P I tbm
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Address: X IWA
City:Yf 0 VCQ��i
Zip Code: 32.Q�O,I Fax:
Phone Noll?_-`'t�3—(D401
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If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPL M NTAL GC7NSTRU�--TJ0 LIEbN LAW INFORMATIaN�
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DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY: _ 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:
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 OM ENCEMENT MUST BE RECORDED AND
POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF D TO OBTAIN FINANCING, CONSULT
WITH YOUR LEND OR AN ATTORNEY BEFORE RECORDING YOU C F COMMENCEMENT."
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Signa ure of Own (/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
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The fgr�oing instrument was acknowledgbefore me
this day of OCAtlbe,,r 20 by
The forgoing instr me t was acknowledged before me
this �. day of Wftbc2019 by
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Name of person making statement.
Name of person making st0tement.
Personally Known OR Produced Identification
Personally Known ( OR Produced Identification
Type of Identification
Type of Identification
ro ed
Produced
Si nature of Notar Pu ic- Sta ida 1 WHI7LEY CEc
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notary Public State of Flor
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 2/7/19