HomeMy WebLinkAboutCCF02062018_00001ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
,� Permit Number:
Date: ��
nuiiaing rermit Hpplicavon
planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 Residential
Phone: (772) 452-1553 Fax: (772) 462-1578 Commercial
PEKMI I APPLICA I ION FOR: To Select from dropbox, click arrow at the end of line
PKU_I'OSED IMNKO_V_EME_N I LOC:_AI ION:
Address: -- — �% d SG Al A 14
Legal Description:
/��0�."`NQS/ r�
Property Tax ID Lot No.
#:
Block No.
Site Plan Name:
Project Name:
Setbacks Front
Back: Right Side: Left Side:
DE I AILED DESCKIP I ION OF WORK:
t� �D� (✓/���� 2��� � i/Stcr C-�p,nSc_ i s'/tc✓
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CONSTRUCTION INFORMATION:
ona work o e er rme un er t is permit – c ec aM app
HVAC E. Gas Tank ❑Gas Piping _ Shutters
0 Electric 11 Plumbing Sprinklers Generator
—
Total Sq. Ft of Construction: Sq. Ft. of First Floor:��jj
.S A- -- Utilities: L]Sewer[]Septic
Cost of Construction: $ __
OWNER/LESSEE:
Name �fLu[� d 7 �'�►� H k k f tCl�
Address: `%00
�Q State:
City:
Zip Code: 7 4 q J5 S Fax:
Phone No. 71a 4 b I 0' -� C'
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
CONTRACTOR:
QW indows/Doors
L1Roof Roof pitch
Building Height:
Name:
Ci'�T(� �51^Ant�•v\cnS
tem-
Cu3 T G t1 l J r L1 S L e m S
Company:
Company:
l�
Address:
City. Po R -i 9t. Luc (t-,- State: r�
Zip Code:
`f 452 Fax: 77,? -.j'3 15-1 q
Phone No.
i '� 335- 3 2 3
E -Mail:
C u S t ct i t s Cc 0 C b rrn
A C C" J 8 1 0
State or County
License:
_ _ ,-----
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENIALCONSIRUC IION LIEN LAW INFURMAIION:
DESlGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
City: State:
Zip: Phone:
Address:
City: State:
i
Zip: Phone:
i
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
Address: i
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
which is in contlict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Horne 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 &dth the approved pians, 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, x&,alls, 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 re c ding your Notice of Commencement.
s
Signature of Contractor/License Holder
Signature of Owner/ essee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF X-6 L U C` l e
STATE OF FLORIDA ('
COUNTY OF
The forgoing instrument was acknowledged before me
this b day of FP- 1) 20 t 3 by
The forgoing instrument was acknowledged before me
this day of 20 I ( by
eurbs I4artMor? S'
6ArLTI 5 SLnmImon 5 '
(Name of person ackno.ztedging)
(Name of person acknowledging)
_ L �LQif. �-ii.-�� � i G 5✓/ V
2�Q/GC-: t�C-� ''G -7— �_/ i
(Signature of Notary Public- State of F! a)
(Signature of Notary Public- Stat of Flori
Personally Known ✓ OR Produced Identification
Type of Identification Produced
/r� �1 I �/ CHRt5T1NE8
Commission No_ l C, C 5nc ,� `'f b a
Personally Known OR Produced Identification
Type of Identification Produced
mission No. l7l AlG� GHk�?;;.�' ;*
MYCOMMISSIM
EXPIRES: Api
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Revised 07/15/2014
052516 * ;•. i
2021
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