HomeMy WebLinkAboutCCF08232017_00000ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
•
i5milaing vermis Applicavon
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
PEKMI I ANI'LICA I ION FOR: To Select from dropbox, click arrow at the end of fine
PROPOSED IMPROVEMEN I LOCAI ION:
Address: &'O-�"
Legal Description:
Property Tax ID #: �yu�S -«�- � 7 - ` 7
Lot No.
Site Plan Name:
Block No.
Project Name:
Setbacks Front Back: Right Side:
Left Side:
UE 1 AlLEU UESCKIP I ION O1- WORK:
CONSTRUCTION INFORMATION:
A-ddTtiona_5 orTc to—Ge er�rmea un3e�is permit - cFieck iT appiy: --
1JHVAC F] Gas Tank ❑Gas Piping Shutters Windows/Doors
11 Electric Plumbing Sprinklers
Generator Roof Roof pitch
Total Sq. Ft of Construction:
Sq. Ft. of First Floor:
Cost of Construction: $ y-3.47 Utilities: Sewer Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
-- ------
Name
Name: G u is T rpt oAc r1
Address:
Company: t l i o rpt A �_ - Sq S
City: State: "4
Address: 1415 S t
Zip Code: Fax:
City: PC, P -T 9t, !_ vc � � ✓ State: { � j
Phone No. 7�,Z ��'S� �� �/�
Zip Code: Fax
E -Mail:
Phone No. ! '� 3 3:5- " l 3 r
Fill in fee simple Title Holder on next page( if different
E -Mail: C u 5 t c, I r 5 y 4 Cc e, on.. J
from the Owner listed above)
State or County License: C' S i F 10
i
if value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMEN IAL CONS I RUC I ION LIEN LAW INFORMAI ION:
I
DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
_
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone:
Zip: Phone:
1
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
�I
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
commencing work or recoirding your Notice of Commencement.
i
s i
Signature of Owner/ essee/Contractor as Agent for Owner Signature of Contrac orhicense Holder I
STATE OF FLORIDA / STATE OF FLORIDA r
COUNTY OF COUNTY OF_ t0� t✓Ue/::C. 3
3
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this fr day of 20 LLby this day of CZ 20 �%by
- euros �nmmoy?s 12T1 S gnmmotA S
(Name of person acknowledging j (Name of person acknowledging)
(Signature of Notary Public- State of FI a) (Signature of Notary Public- Stat of Flori
Personally Known "-/"
OR Produced Identification Personalty Known OR Produced Identification
Type of Identification Produced Type of Identification Produced
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Commission No. (i 6 0 Sd � Y ° CHRISTINE89 4 0 5 �C ✓M C, a� `f• �k u1 ,r
mission No. prv;-:,:. •..: E
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* :INYCOMMISSIONae 05231E
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Revised 07/15/2014 *�* MYCOMANSSIONSGOoSM
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