HomeMy WebLinkAboutCCF01082018_00001ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION To BE ACCEPTED
Date:
Permit Number:
� S-/�
s
dUllaing rermn AppliCavon
Planning and Development Services
Building and Code Regulation Division
23oo Virginia Avenue, Fort Pierce FL 34982 Residential
Phone: (772) 462-1553 Fax: (772) 462-!578 Commercial
PEKMI I APPLICA I ION FUR: To Select from dropbox, click arrow at the end of fine
pROYOSLUIMPKOVEMENI LUCAIION:
Address:
Legal Description:
���G Lot No.
Property Tax ID #: 7 Block No.
Site Plan Name:
Project Name:
Setbacks Front__.
Back: Right Side: Left Side:
UE I AILEL) UtSCKIP I ION OF WOKK:
CONSTRUCTION INFORMATION:
AadEtionworto rm
ec ui3era
HVAC
Gas Tank
Electric 0 Plumbing
Total Sq. Ft of Construction: Cost of Construction:
$
OWNER/LESSEE:
i
this permit - c�ieck a app -TY ------- ---
as Piping Shutters F—IWindows/Doors
Sprin klers
Generator L] Roof Roof itch
Sq. Ft. of First Floor
Utilities: Q Sewer ElSeptic
CONTRACTOR:
Name
Address
T� i'Ct�%l,>'l�2
City: State:2L
Zip code:
Phone No. 79d i17D
E -Mail: F�rrf�p/��1fravii�nCc �P Sate �'�,�?
Fill in fee simple Title Holder on next page { if different
from the Owner listed above)
Building Height:
Name: Gi't�c'Ttr �A6k0"c2J
Company: C u Ptit A r c
Address: _� 15 G 1%' t (dG �1 r ee i1 l� �'
City: Po 2T St . L State:
x+451 Fax
Zip Code:
Phone No. .7 ,1 33:5- 3 2 3 2
E -Mail CLt Stc�ir s`+� Cccl CGVs�
State or County License: C� C C? J l e i C,
If value of construction is $2500 or more, a RECORDED Notice of Commencernent is required.
SUPPLEM EN 1 AL CONS I RUC I ION LIEN LAW INFORMA I ION:
DESIGNER/ENGI
Name:
Address:
City:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone: _
Not Appli
State
Not Applicable
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: __ Phone:
BONDING COMPANY:
Name:
Address:
City:
Z p: Phone:
Not Applicable
tate:
_Not Applicable
I certify that no work or installation has commenced prior to the issuance of a permit.
St_ Lucie County makes no representation that is grnting 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 restrictY rprohibit 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
WARN ING TO OWNER. Your failure toRecord
ofa Notice of Commencement Commence be recordedmerit uatnd in post our d on theljobsite
improvements to your property.
before the first inspection. If you Intend to obtain financing, consult with lender or an attorney before
commencing work or recoding your Notice of Commencement.
1
L/� ✓ '
Signature of Owner/ essee/Contractor as Agent for Owner Signature of Contra or/License Holder
SSTATE OF FLORIDA
COUNTY OF
COUNTY OF
TATE OF FLORIDA ZI
y
The forgoing instrument was acknowledged before me
The for oing instrument was acknowledged before me this day of �Th`/J 20 1 S by
this ' day of 7 1A) 20 �J_bp
�ur�IS ��fmm�Y►S �,cf.,T+ S
j (Name of person acknowledging)
(Name of person acknowledging
(Signature of Notary Public- Stat of Flori
(Signature of Notary Public- State of F1 a } Personally Known V"'
OR Produced Identification OR Produced Identification
Personalty Known Type of Identification Produced
Type of identification Produced (�srru
/' �� CHR
C#iRIS711 B mission No. ►Jt 1 "1
Commission No. U1 C, Q 5 ' 7� MYCOMMMM"* own .} �;
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Revised 07115/2014 a� o� E)Sr s:Apd4,Z2I
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