HomeMy WebLinkAboutCCF08252017ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: g ' an - II Permit Number:
ouifaing rermix Appilicavon
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-2553 Fax: (772) 462-1578 Commercial Residential
FERMI I APPLI(A I ION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROV
Address 9
Legal Description:
EN I LOCAI ION:
Q (L
Property Tax ID #: 330L rl03 ^ O '+�- 00b - 7 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back:
DE I AILED DESCRIP i ION OF WORK:
Right Side: Left Side:
i lyse=s CAA)"se 01;'k' 5 /� �✓
CONSTRUCTION INFORMATION:
Additionalworo e Perrme under t is permit - c ec a appy:
HVAC GasTank [:]Gas Piping _Shutters Windows/Doors
11 Electric Plumbing ❑Sprinklers Generator Roof Roof pitch
Q
Total Sq. Ft of Construction:
Cost of Construction: $ 0
l
OWNER/LESSEE:
Sq. Ft. of First Floor:_
Utilities: 0 Sewer a Septic
Name lW i 1\ Q M CD' r,0 QnC'
Address: l ty $ 8 DUQU eSn o .
City: P9 knrcrQ—, State: C0
Zip Code: c6 M 1 Fax:
Phone No. Rrl2 - $q 3 - Q51 ,::�
E -Mail:
RII in fee simple Title Holder on next page ( if different
from the Owner listed above)
CONTRACTOR:
Building Height:
Name: G i' 1i Z l-, rS N a D1'1 C r1
Company: Clu -ro nk A % r S �.� S t em'- (n: c-
Address:
City:
PU P -T St , L u c i c- State: ri
Zip Code: 3 LFq 5�. - Fax '77J j 3 -
r
Phone No. '� 3 3 5- 3 2- 3 2
E -Mail: O u s t C� i r- s ti,-pQ C/ C 6 vrt
State or County License: C 4 cc) 5 ( ,F ( 0
ff value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMEN IAL C ON -5I KUC:I ION LIEN LAW INFORMAI ION:
DESIGN ER/ENGINEER: Not Applicable
MORTGAGE COMPANY: _ Not Applicable i
Name:
Name:
Address:
Address: j
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 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 recpfding your Notice of Commencement.
s
Signature of Owner/ essee/Contractor as Agent for Owner Signature of Contractor/License Holder
i
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OFCOUNTY OF
The for oing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of >Otuqo5i,- 20 n -by this 25 day of 20 \'I by
i
- eurbS �Igmmor7S C-ulzrl S �Ji�m�Ur1 S- 1
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public- State of FI a) (Signature of Notary Public- Stat of Flori
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Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced
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Commission No. U l C7 0 54 76 CHRIVIMB mission No. C4 Q b oc 501 r1g-
MYCOMMISSIONf 34305M
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Revised 07/15/2014 ** MYcommimMOGc;;ORM
�`o� EXPIRES: Apra b 2011
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INITIALS j