HomeMy WebLinkAboutCCF08042017ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: (3 - 7 / Permit Number:
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Residential
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
pRopo_5)=U IMPKOVEMENI LUCAIION: _
Address: .2
Legal Description:
Property Tax ID #:
Site Plan Name:
701-- 0 16:20 DUD
Project Name:
Setbacks Front Back: Right Side:
DE I AILED DESCKIP I ION OF WOKK:
Left Side:
Gl
ISG l2'� LIJ�g 5'T �^ Z3 Seer CI,PrSc � �j%i c�
CONSTRUCTION INFORMATION:
Adaifion w -- -Eo 6e er�ormed -und � this permit = cl
HVAC 11 Gas Tank ❑Gas Piping
11 Electric D Plumbing Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ 70 -
OWNER/LESSEE:
Nam
1 T / it l _
Lot No.
Block No.
tm appiy:
Shutters Q Windows/Doors
Generator L Roof Roof pitch
Sq. Ft. of First Floor: _
Utilities: oSewerF-]Septic
City: (Ire State:
Zip Code � �9 Fax: ( /
Phone No. 702 ' 6/ 6:2V
E -Mail:
Fill in fee simple Title Holder on next page { if different
from the Owner listed above)
CONTRACTOR:
me•
Building Height:
at L' V\ c 0
Company: ('to cc, n -s A , f
Co
Address: i 4" 1 � i �; 1 Cxc, .� r ee rf
City: pop --v '9t, Loci e_ J State: r
Zip Code: `F° 5;� - Fax: '71-2 - j 3 _ I c
Phone No. '7 a- 33:5- ` � .2 3 `L
E -Mail: Cu StCccl <<✓7ti
State or County License:
f�Cc.35I,F(`)
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
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SUPPLEMEN IAL C:UNS I RUC:I IUN LIEN LAW INFURMAI IUN:
QESIGNER/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:
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 pians, 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 aCCeSSOrV Uses tO another non-residential use
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in your paying twice far
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 reca ding your Notice of Commencement.
i
S
Signature of Owner/ essee/Contractor as Agent for Owner
Signature of Contmr r/License Holder a
STATE OF FLORIDA/
COUNTY OF P e
i
STATE OF FLORIDA
COUNTY UC
OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this day of _V, 20 nby
this C4 day of 20 (�( by
euros �RmM62r?
v
C�ur2T1 5 stimmon 5
(Name of person acknowledging)
{Name of person acknowledging)
L'L.Ld C �-9Cx� iV_4
(Signature of Notary Public- State of FI a)
(Signature of Notary Public- Stat of Flori
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification Produced_ _
Type of Identification Produced
/� �J � / / CHRISTINE B E
Commission No. Ul Q 5nc 7b at�,� ►
' �+ ,t P% CHMIr"1 �' .? 1;Ni
MHimission No. [)l tri o
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MY COMMMION O
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EXPIRES: Apn1
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202t_ . _ 41Rr ► '�"�� s
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Revised 07/15/2014
* * MY COMMISSION #GG052546
o�\o� EXPIRES: Apr 14,2021
P
REVIEWS FRONT ZONING SUPERVISOR
PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW ; REVIEW
REVIEWREVIEW REVIEW REVIEW
DATE
i
COMPLETE
INITIALS
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