HomeMy WebLinkAboutCCF10122017_00000ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: { a -C] Permit Number:
MEN•
nuimirig Y@rifTllii Appi1Cavon
Punning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 402-1553 Fax: (772) 462-1578 Commercial Residential
PEKMI I APPLICA I ION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPKOVEMEN I LUCA1 ION: -
Address: 7s'yL pr
Legal Description:
Property Tax ID #: 5 ` d �� Lot No.
Block No.
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
DE I AILED DESCKIP I ION OF WORK:
CONSTRUCTION INFORMATION:
AaditlOna wor to a er rmea `un er t is pe�mtt = cl
HVAC Gas Tank []Gas Piping
11 Electric Plumbing Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ _S�il O
OWNERAESSEE:
"Shutters LiWindows/Doors
12 Generator F]Roof = Roof pitch
Sq. Ft. of First Floor: _
Utilities: 1:1 Sewer E]Septic
Nanie ST Luc(*_'
Address: O
City: State: FL
Zip Code: `i qJ��. Fax:
Phone No. >57q - C q (6 .
E -Mail -
RI I
-Mail•FII in fee simple Title Holder on next page ( if different
from the Owner listed above)
CONTRACTOR:
Building Height:
Name:
C('('T(r i)s`irko'\Crl"
Cam pany:
Cu n -Tc rpt A
c' eyK S l ti c,
Address:
I �i' l 5 L�' I (U
G t ee r1 l�
City: Co 2T" St . L u c z e-
State: r�-
Zip Code:
4 q5)
Fax
Phone No.
a_33:5-
- 3 a
E -Mail:
Cu 3tc.Ir
Sys ectal c_tE�u
State or County License:
GC.' 5 19 �l
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMEN I AL CONS I KUL I ION LIEN LAW INI-UKMA i ION:
DESIGNER/ENGINEER: — Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
State:
City: State:
City:
Zip: Phone:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City:
Zip: Phone:
City:
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
rules,aprohibit such
or which maor
ev ew your deed any restrictions
structure. Please consult witapplicable
yolurHome Owners Association and
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 rec ding your Notice of Commencement.
i
i
s
Signature of Owner/ essee/Contractor as Agent for Owner Signature of Contrac or/License Holder i'
STATE OF FLORIDA STATE OF FLORIDA
�� �U COUNTY OF_
COUNTY OF C'! e
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
1 by
this /oL day of OCT 20 i? by this I d. day of CC T 20
- '�J mM0n S
Curtis � 14 M rnc�n S' � IZTI S
(Name of person acknowledging } (Name of person acknowledging)
/ �/�L �G.�i
.
(SignatureofNotary 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
/� /� C / / ? n ,Y PQ* CHklsTit.`t > *.
No. U1 (17 J Yb dct`� �TINE8 mission No. Vl U/ cam' ✓ oC S`1 c% '� moi+*
Commission : * myCOMMISSONi 3G 052518
a�\ EXPIRES: Apra_.1021 •r '�'g �'s:a _
-- -- --- --- ?a aaa.a nn, e�aq.r►+ary s«aoK * * My COWASSION: rA 062518
Reti-ised 07/15/2014 �� E)MMAM4,20211
i
REVIEWS FRONT ZONING SUPERVISOR j PLANS VEGETATION SEA TURTLE MANGROVE
' REVIEW ! REVIEW REVIEW REVIEW REVIEW
COUNTER REVIEW
DATE
COMPLETE
INITIALS __-
062548