HomeMy WebLinkAboutCCF03152018_00000ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: / Permit Number:
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Planning and Development Services
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Building and Code Regulation Division
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113TGm A �r S'
2300 Virginia Avenue, Fort Pierce FL 34982 Residential
Phone: (772) 452-1553 Fax- (772) 462-3.578 Commercial
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142,15 V, I l as -
PEKMI I APPUCA I ION FOR: To Select from dropbox, click arrow at the end of line
zip Code:
PROPOSED IMPKOVLMENI LUCAIION: ��
Phone No.
Address. ___ ✓��'r7� �� ��1T�j/-�t
E -Mail:
Legal Description:
State or County License: 'q G C' 5
- -�
Lot No.
Property Tax ID 9:
Block No.
Site Pian Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
Ut I AIL) U UESC KIt' I ION OF WOKK:
Jcc:r �h�tnjc o 6,4S 1z.,10A
LlKc- 3
L/It'r �_'�3-r"-�o
CONSTRUCTION INFORMATION:
ona wo o e rme un er is permit — c ieca app
Gas Tank []Gas Piping _ Shutters t_1 W indows%Doors
- VAC
OSprinklers ll Generator Q Roof
Roof pitch
OElectric Plumbing
Total Sq. Ft of Construction: Sq. Ft. of First Floor -
Cost of Construction: $ 6 ' 0 Utilities: 0 Sewer ElSeptic Building
Height --
OWNER/LESSEE:
Name D Sire e a LcWt
Address: -
City: 10,1a State: v L
Zip Code: Fax:
Phone No.
E -Mail:
Fill in fee simple Title Holder on next Page ( if different
from the Owner listed above)
CONTRACTOR:
Name:
�i,'�CZ(S ��MD'MCnS
Company:
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113TGm A �r S'
Address:
;e
142,15 V, I l as -
Cit I D R t S> L u c i State: r�—
zip Code:
H'452- Fax
Phone No.
1 -11 3 3:5- 3 2 3
E -Mail:
S t a i r s ti s Q l C r. vn
State or County License: 'q G C' 5
f# value of oonstruCtion i 00 s $25or more, a RECORDED Notice of Commencement is required.
SUNNLEMENIALCONS IRUC IION LIEN LAW INFORMAIION:
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:
Address:
Address:
City:
Zip: Phone:
City: I
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
ay ay apply bit such
is in for any
swhich
co1ctwith tructure. Please consult withP our Hlome owners Association and review your deed restrictions which
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 or rec ding your Notice of Commencement.
s
Signature of Owner/ see/Contractor as Agent for O•.wner Signature of Contra or/License Holder
STATE OF FLORIDA STATE OF FLORIDA
X� LU C` 1 E COUNTY OF t.yC-F
COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this ) day of(1/Llz �U 20 by
this _J# day of IIILVLG%• v 20 (Lb�r ,
' SJR Yyt o�1G� i!1 S
(Name of person acknowledging) (Name of person acknowledging)
G
of Notary Pu/blic- State of FI a) (Signature of Notary Public- Stat o41ori*::�
(Signature
Personally KnownOR Produced Identification
Personally Known ✓ OR Produced Identification
Type of Identification Produced i
Type of Identification Produced
al �J 0
Ci 0 �� � q 43aPf� CHRISTINE B mission No.
Commission No_ �=� * I
* myco�iMOSIoN: 052546
it � ExPIRES Apd • 2021
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AAA* My CMIS5M # GG 05M
Revised 0�/15i3014 moo. 8MMS:Aprr4,2021
REVIEWS FRONT ZONING SUPERVISOR I PLANS ` VEGETATION SEA TURTLE MANGROVE
l REVIEW ; REVIEW REVIEW REVIEW
COUNTER REVIEW REVIEW
DATE
COMPLETE
'
INITIALS