HomeMy WebLinkAboutCCF03012017_00000.PP LICABLE INFO MUST BE COMPLETED FOR APPLICATION' TO BE ACCEPTED
Date: �-/ ('7
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Permit Number:
Building Permit Application
Commercial
Address: ►3,1"zy 6414c, f"
Legal Description:
Property Tax ID #: J i(d 15_ %CJS-" OC 3 8 ` rf rr _ 3
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
Residential
Lll
L11(e / ySCys 0, P, A,s L a– , l p /4
Lot No.
Block No.
� Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator _ _ Roof
Total Sq. Ft of Construction:
Cost of Construction: $ ? G ;'
Name 1n,kAm o�jth.L-fh t`617CiSc
Sq. Ft. of First Floor:
Utilities: —Sewer _ Septic Building Height:
Address: SC3 to s-4' CrcLd RSI
City: W � 18 vicod 0i -est State:
Zip Code: E$2 (c C Fax:
Phone No. � e G — SCS— Je4 I
E -Mail
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Name: Curt(5_ 'sa-mynon S
Company: C'us-re m A t'r 5!� S i'e nes ) Il) c.
Address: Ili i S S 6 T, 1(la y Q r rt Dr
City: PO
c d State:
T d�i �kC 1�
Zip Code: 34 q_52-) Fax: 97; 33S 146 F
Phone No. 771 3�,5 -3232
E -Mail: CUstoor au
State or County License: Cfl C o 5 I $ !O She
if value of construction is 25WOr more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
State
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY:
Name: _
Address:
City:_
Zip:
Phone:
State:
Not Applicable
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
rnmmencine work or recordkmR vour Notice of Commencement. /I
Rev. 7/2014
Signature of Owner/ Agent/ Lessee
Signature of Contractor License Holder
STATE OF FLORIDA
SZ/
STATE OF FLORIDA
COUNTY OF
COUNTY OF --
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this / day of , 20� by
this / day of 20_',LZ by
��i,crir; �H,�1mcnS
�t;tr�+s �Hmm���S
(Name of person acknowledging)
I
(Name of person acknowledging )
(Signature of Notary Public- St to of FI ida)
a )
(Signature of Notary Public- State of Flo,4a
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification Produced
Type of Identification Produced
.o��`Y•::' - CHRIS11NE B. ENGLISH
Commission No. Z7,6 S �U *' e41)1YCOMMISSION #EE8592
`c CHRISTINE B. ENGLISH
"—Commission No. EEd'S1/,���i * �)�,1YSSION EE 85928
EXXPIREPIRES' April4; 2017
EXPIRES: April 4, 2017
s,� a=
FCF F10� BO:�(I?C ThN Budget NotarySgYICE
FIiF Bonded 1� Budget NOi21Y S
RFVIFWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 7/2014