HomeMy WebLinkAboutCCF10122017_00001ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: /C /'� -/7-
Permit Number:
•
csunaing rermn Appiicazllvn
Planning and Development Services
Building and Code Regulation Division /
2300 Orginia Avenue, Fort Pierce FL 34982 Residential (�J/
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial
PEKMI I APPLICA I ION FUR: To Select from dropbox, click arrow at the end of line
pR0pOSEU IMPROVEMEN I L_OC_Al ION:
Address:-----7f1d 6)
Legal Description:
Property Tax ID #: ���� r%`� Lot No.
Block No.
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
DEIAILEU UESCKIPIIUN OF WORK:
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CONSTRUCTION INFORMATION:
-���-+�.�rtiN���tnTen--er�ormed- uncTer
HVAC( Gas Tank
11 Electric U Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ S� 7
OWNERAESSEE:
this permit - cnecK an apply:
[]Gas Piping ShuttersWindows/Doors
Sprinklers 11 Generator FIRoof Roof titch
Sq. Ft. of First Floor:
Utilities: o Sewer E]Septic
Name eve`, n k1 b p�
Address: % (o I LJ (hiym� a- d-�
City: P `� c� t�:o Q b l l Leel _ State: _A
Zip Code: l q I l? Fax:
Phone No. 15 7 � - C q 5 . -
E -Mail: do AV, bol � -�Cm, Gtr
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
CONTRACTOR:
Building Height:
Name:
Ci'r"T(` A 6r kV\Cr15
Company:
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S,-, s 'E e<vt
Address:
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City: Cc RT ,St . L v c ('e_
State:
Zip Code:
4+q5--
Fax: `77,? �3�-i5�n
Phone No.
17 .1 1 J7 3 S
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E -Mail:
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State or County
License:
if value of construction is $25oo or more, a RECORDED Notice of Commencement is required.
SUPPLEMEN I AL CONS I RUC ION LIEN LAW INI OKMA1ION:
DES IGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: — Not Applicable i
Name: Name:
Address: Address:
State: City: State:
City: Zip: Phone:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: — Not Applicable
Name:
Address:
r'i+I.
Zip: Phone: _
BONDING COMPANY: _Not Applicable
Name: _
Address:
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
structure. ture. Please consult any
hpyoiur Hlome Owers Association wners Association
andrev rules,
your deed aws or for any estrict ns at which marestrictor
aprohibit such
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 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 Iobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recolyding your Notice of Commencement f^l
Signature of Owner/ essee/Contractor as Agent for Owner Signature of
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
this _�L_ day of OCT 20 +? by
- Curtis �nmmor? S'
(Name of person acknowledging )
(Signature of Notary Public- State of Fl a )
Personally Known ✓/ OR Produced Identification
Type of Identification Produced
D s0 4 6 _ y CHRISTRIE 8 E
Commission No. n * �� * mycMas i
Holder
STATE OF FLORIDA
COUNTY OF t�f UC_I _e
The forgoing instrument was acknowledged before me
this I d- day of CC T 20 17 by
r, T 1 5 stl m vnv n 5
(Name of person acknowledging)
(Signature of Notary Public- Stat of Flori
Personally Known t/ OR Produced Identification
Type of Identification Produced '
GHkISM.Z 3
MYCOMMWIMIMORM
Revised 01//15/2014 �, �� :Ap14,2 tt
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