HomeMy WebLinkAboutCCF03162018ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ✓ - a Permit Number:
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nuillaing rermix Appucavon
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 452-1553 Fax: (772) 462-1578 Commercial Residential
i'1=KM1 I APPLICA I ION FOR: To Select from dropbox, click arrow at the end of line
PHOP_U_SED I_MI'_ROVEM_ EN I WC_AI; ION:
Address:
Legal Description:
50q
Property Tax ID #: at 3 C `7 �� �� l ! Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back:
UE I AILED DF -SCRIP i ION OF WORK:
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_ Right Side: Left Side:
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CONSTRUCTION INFORMATION:
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/HVAC
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Gas Tank
[]Gas Piping
hutters
Electric
U Plumbing
Sprinklers
Generator
Total Sq. Ft of Construction:
Cost of Construction: $
OWNER/LESSEE:
Sq. Ft. of First Floor:
Utilities: 0 Sewer E] Septic
Name nM.Mend a -J--01( L1 ru✓ ICIR LO UL/fi ,
Address: A I A � 504
City: �i U fi: (� i n 5 o n I Sl a/nd State: F)
Zip Code: Fax:
Phone No.
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
CONTRACTOR:
❑,Windows/Doors
F]Roof Roof pitch
Building Height:
Name:
CU (ell S 0A64LOAc%tIZ,
Company:
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Address:
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City: 6 Rr 9t . L u c (c_ - State --
tate:Zip
Zi pCode:
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Phone No.
E -Mail:
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State or County License:
if value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
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SUPPLEM EN 1 AL CONS I RUC I ION LIEN LAW I NFORMA 1 ION:
DESIGN ER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
_
Name:
Address:
Ad d ress:
City- State:
City: State:
Zip: Phone:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: — Not Applicable
BONDING COMPANY: _Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
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I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie Countvmakes 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 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 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 twicefor
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 recording your Notice of Commencement.
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Signature of Contractor/License HolderSTATE
Signature of Owner/ essee/Contractor as Agent or Owner
OF
COUNTY OF �� �U�/
FLORIDA
UT
COUNTY
The for oing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this day of Ii)m[ iJ 20 1-by
this day of AtalL,4 20 tV by
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(Name of person acknoMedging }
(Name of person acknowledging)
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(Signature Notary Public- State
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of of FI a)
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(Signature of Notary Public- Stat of Flori
17,
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification Produced _
Type of Identification Produced
Por :, �
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Commission No. lii C7 05, 7 [! a°{ CHRISTINE 8 t;
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Revised 07/151201
My COMMISSION GG 05M
EXPIRES: Apdt a, 2021
REVIEWS FRONT ZONING SUPERVISOR
PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW ;
REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
I
INITIALS
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