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HomeMy WebLinkAboutCCF02052018ALL APPLICABLE INFO BE COMPLETED FOR APPLICATION TO BE ACCEPTED ddMUST Date: 02 5 ' I 0 Permit Number: J } auttaing vermix Appncavon Punning and Development Services Building and Code Regulation Division / 2300 Virginia Avenue, Fort Pierce FL 34982 Phone: (772) 462-1553 Fax: (772) 452-1578 Commercial Residential PERM I APPLICA I ION FOR: To Select from dropbox, click arrow at the end of line � i i PttOPOStU IMPKOVtMhNN 1 LOCAI ION: CJD r-�- 0-.1 Address: Legal Description: `1 ) i { d bb -s Lot No. Property Tax ID #: v� I Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: 1 UI:I AILED UtSC KIP I IOM OF WORK: L Ikl2. For ------------------- CONSTRUCTION INFORMATION: _--- -- a wor o e er rme un er t is permit -i�m c ec a app HVAC �GasTank [:]GasaWindows/Doors Piping_Shutters Roof pitch Electric Plumbing ❑Sprinklers Generator t] Roof Total Sq. Ft of Construction: Sq. Ft. of First Floor: o � Height: Cost of Construction: 5. yg 4� Utilities: Sewer Septic Building OWNER/LESSEE: CONTRACTOR: Name Name: Ci'�Tl S ,SN 6t iv1Cr7S C1137orpt r 5u Ste n c Address: � POr-l-�pi Company: �© S� Lc Y':Q Stater. Address: ts 6 City: + Zip Code: �3c9� Fax: City: l U P- -r St . ucc e. State: r7la ' � �� " Q Zip Code: Fax Phone No. Phone No. i 'l a 3 3:5- - 3 )- 3 2 E-Mail: RI in fee simple Title Holder on next page { if different E-Mail: C u S t c11r StiICcC)I � R CC 519 (0 from the Owner listed above) State or County License: If value of construction is $2500 or more, a RECORDED Notice of commencement is required. Reprised 07/15/2014 ��Ol M1��_—BonAad Thu BudpM Nary Swka MYCWM=0N#GG0(g EMRM: Awl a- 2Mi SUPPLEMENIALCONS IRUC IION LIEN LAW INFORMAIION: DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable j Name: _ Name: I Address: Address: City: State: Zip: Phone: City: State: Zip: Phone: FEE SIMPLE TITLE HOLDER: — Not Applicable BONDING COMPANY: Not Applicable Name: Name: Address: Address: City: City: Zip: Phone: ZIP:i Phone: i I certify that no work or installation has commenced prior to the issuance of a permit. which chis inoconfict With any as no pplicable Home O isAssociation rules bylaws or land permit nlantds that build or prokiibit 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 your Notice of Commencement. qrecoding I s Signature of Owner/_ essee/Contractor as Agent for Owner Signature of Contractor/License Holder 1 STATE OF FLORIDA COUNTY OF . STATE OF FLORIDA COUNTY OF LUQ{- The forgoing instrument was acknowledged before me The for i going instrument was acknowledged before me this day of —re ., v 20 ,(�by I this day of �� lQ e-�,- 20 by C Inci1 (Name of person acknowledging } (Name of person acknowledging) (Signature of Notary Public- State of Flgr a } (Signature of Notary Public- Stat of Flori Personally Known ✓ OR Produced Identification Personally Known 1/OR Produced Identification Type of Identification Produced _ Type of Identification Produced I Commission No. / C 0GtS oMn ®,Ya°,gMrc8 PGc52s4 w ! FXMFS-Awl *CrH�R:IC. Tit+".r mission NoMY r I smt Reprised 07/15/2014 ��Ol M1��_—BonAad Thu BudpM Nary Swka MYCWM=0N#GG0(g EMRM: Awl a- 2Mi ISH O&MI i -- REVIEWS FRONT ZONING SUPERVISOR I PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE COMPLETE I INITIALS i ISH O&MI