HomeMy WebLinkAboutCCF08042017_0001ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: D " Y — L-7 Permit Number:
rsuliming rermn: Hppicavon
Planning and Development Services
Building and Code Regulation Division
23oo Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial f' Residential
PEKMI I ANI'LICA I IUN FOK: To Select from dropbox, click arrow at the end of line
1'KU!'USI=U IMt'KUVtMLN 1 LOCA
I ION:
Address:
Legal Description:
Property Tax ID #: 34D5 76q_... l a Q a' Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back:
UE I AILED UESCKIP I ION 01- WORK:
Right Side: Left Side:
i3se-{ C�Ar'sc ofr /0 /t w✓
CONSTRUCTION INFORMATION:
-Add o-TworTc to—Geer c rmed -under this permit - c ec cTa
-IVAC Li Gas Tank ❑Gas Piping
11 Electric 1i Plumbing 0Sprinklers
Fapp Ty� -----
Shutters Windows/Doors
ElGenerator F]Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor: _
'•� %•
Cost of Construction: $ .$ Utilities: El Sewer _Septic
OWNER/LESSEE:
Nam
Address,3 �%� nom_ ba
City: 1brt Se 1cx( .Q State: Z
Zip Coder a Fax: q
Phone No. %7a k /
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
CONTRACTOR:
Building Height:
,Name: C.L"r, l< 'F1 titati1c�1�
Company: 6(,o"ro m A
Address: i 4,1$ S 6 �l ! i aQ
City: Po 2T 9t, v c State: -�
Zip Code: +q Fax: 7'r1 1��_ic �<
Phone No. T1 a- 3.35' 31 3 L
E -Mail: Cu 5tCr, C, cCvs2
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State or County License: C} r� C' J 1 F
if value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMEN IAL C;UNS I RUC:I IUN LIEN LAW INFURMA I IUN:
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 recording your Notice of Commencement.
s
Signature of Owner/ essee/Contractor as Agent for Owner
Signature of Contrac r/License Holder I
i
STATE OF FLORIDA !
�� e
STATE OF FLORIDA (, '
COUNTY OF ,t, U (`%
COUNTY OF C/�
The for oing instrument was acknowledgetij�efore the
this day of 20 20 ! /_by
The forgoing instr hent was acknowledged before me
this day of 20 L3by
' eu r I S Ki FYl mor? S
eU tzT1 S gnYVl MU n -5
(Name of person acknowledging)
(Name of person acknowledging)
(Signature of Notary Public- Stat of Flori
(Signature of Notary Public- State of FI a)
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification Produced_ _
Type of Identification Produced
Commission No. vl ur 0:q6cu Ya �.� CHRISTINEBENC
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Himission No. �(�S`1 tom' ' ��;:a:.' ; s
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* * MY COMMISSION#�G052W
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EXPIRES:
SOF 1b®P Banded TNu Budget Ndary
2021
CH
ServicesR,•••• � R 81=F1G�ISR
My
Revised 07/15/2014
,, COMMISSION# GG 052548
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EXPIRES: April 4,2021
-44k.
PLANS VEGETATION SEATURTLE MANGROVE
REVIEWS
FRONT ZONING SUPERVISOR
COUNTER REVIEW REVIEW
REVIEW f REVIEW REVIEW REVIEW
DATE
- —
COMPLETE
i
INITIALS
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