HomeMy WebLinkAboutCCF10232017ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: to -1 "i � q Permit Number:
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nuilialing rermn Hpplificemon
Planning and Development Services
Building and Code Regulation Division /
2300 Virginia Avenue, Fort Pierce FL 345182
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
FERMI i APPLICA I ION FOR: To Select from dropbox, click arrow at the end of line I
PROPOSED IMPROVEMEN I LOCAI ION:
Address: IS rS' L,� kQ VJPu, C! r Apt, X05
Legal Description:
Property Tax ID #: 'A a 5-60 - OC 3 ` 000-0, Lot No.
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
Block No.
DEIAILED DESS RIPIION OF WORK: i!
L ffi c /L'' Lp t e
CONSTRUCTION INFORMATION:
7Z�iona work o e er rmea un- erlFiis permit - cmc a apply:Ful ----�—
HVAC Gas Tank j�� as Piping utters Windows Doors
P g Q
11 Electric Plumbing ❑Sprinklers Generator ❑Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ .���0 Utilities: Sewer aSeptic Building Height:
OWNERAESSEE: CONTRACTOR:
Name v 2rL t _ Name: C U rt T I s ,SA 64, pv%c n 5
Address: IS C,5 IY1 OL,% ,YUA- U 6'�Q 4 6k.,1., -k
City: F -0'u IJ( AL2 fl1J Stater
Zip Code: J 4 �4 9 Fax:
Phone No. `l 6 "df20 G
E -Mail:
Fill in fee simple Title Holder on next Page ( if different
from the Owner listed above)
Company: C u S -re, m A, r S 'i ems
Address: 1k-)15 S E V,, 11 eta reei't Q /
City: rc> IZT 9t , E uc(t-- State:-r--t--
Zip
tate:r--t--Zip Code: 50- - Fax: `77� J -3 5-1 q
Phone No. "I.l a 3 3 s- 3)_
E -Mail: Cu at&If- Sys £ Ccc,l•CGvn.
State or County License: f{ CG' SF to
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:
DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: — Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name: I
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone: i
1 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 rec ding your Notice of Commencement.
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Signature of Owner/ essee/Contractor as Agent for Owner Signature of Contractor/License Holder i
i
STATE OF FLORIDA / STATE OF FLORIDA ,
COUNTY OFE COUNTY OF
I
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this /Y day of V64 20 // �b1 this H day of W7- 20 1 % by j
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` eu r ti S 14 FYI Mori S �(,C IZ TI S gn m IMG n S
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(Name of person acknowledging) (Name of person acknowledging)144
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(Signature of Notary Public- State of Fl 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 _
Commission No.Ut 0 gni `tb CHRISTINE mission No. U!
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* * MYCOMMISMili G05M
Rei-ised 07/15/2014 * MYcoMM+sslav:eGos2
EXPIRES: AM 4.2021
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