HomeMy WebLinkAboutCCF05242017_0002.PPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 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:
Address:
Legal Description:
Property Tax ID#: ��� -� _\\_ - Q(1L -Ll Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
/ > yft e- Itrsref _/,a.>,SC :" tr C1tU
....,� F=4 1v111MU u1"uv1 u115 PCFMK—cnecR an inert apply;
—Mechanical _ Gas Tank _ Gas Piping — Shutters _ Windows/Doors
Electric _ Plumbing _ Sprinklers _ Generator Roof
Total Sq. Ft of Construction:
Cost of Construction:
Sq. R. of First Floor:
Utilities: _ Sewer _ Septic Building Height:
Name
Address:_3l
City:Wit= l vC e State: F
Zip Code:, :::�L1O S (G Fax:
Phone No._f2 32-0 - (D--?- O ll
E -Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Name: &Lrtt5 Sa-mmon
Company: CAus-rbrn Lr 5!4 sfe ins N c, _.
Address: t4lS SE it i l lage Q ren Dr -
OW: P012-7 ST LIV kc- State: R,
Zip Code: 34 Fax: `17a 33S 14b
Phone No. 33,5 - 3 �_3 2
E -Mail: CIistcOr c!, -, V C�o I -cern
State or County License: CA C D 51 /O She
If value of construction is 2SWor more, a RECORDED Notice of Commencement is required.
SUETSLE.MENIALCONS IHUCIION 'LILN LAW INt-ORMAIION'
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone:
Zip: Phone:
i
FEE SIMPLE TITLE HOLDER: — Not Applicable
BONDING COMPANY: _Not Applicable
Name:
Name:
Address:
Address: _
City:
City:
Zip: Phone: _
Zip: Phone:
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 exemptfrom 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 rec ding your Notice of Commencement.
s
Signature of Contractor/License Holder
Signature of Owner/ essee/Contractor as Agent for Owner
STATE OF FLORIDAr !
el E
STATE OF FLORIDA
COUNTY OF_
COUNTY OF �J �(. i)
I
The for Ding instrument was acknowledged before me
The forgoing instrument was acknowledged before me
g g g
this asp day of_ 20 I i by
this ;L5 day of 20 CJ by
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�Urb �igrnMoil S'
�
LL QTI5 Am01ai1 S
(Name of person acknowledging)
(Name of person acknowledging)
(Signature of Notary Public- State of Fl a)
f r Public- Stat . of FloridAM
(Signature o Notay
OR Produced Identification
Personally Known OR Produced Identification _
Personally Known
_✓
Type of Identification Produced_ _
Type of Identification ProducedVP
Commission No. Uf �1 Q �b raP 1+ CHRISTINEB
MY COMMISSION f0
mEXPIR......
CHRI"4nN111 IN_
mission No. t1! S11 /� * �-
052518
A
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Revised 07/15/2014
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2021 ( rP �y
MYCOMMISSION800052516
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EMIRES:�4=1
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REVIEWS FRONT ZONING SUPERVISOR
PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW
REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS j j
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