HomeMy WebLinkAboutCCF04092018_00000ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
V_ y -4.Permit Number:
•
ouliaing rermix Appl1cavon
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 Residential
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial
FERMI I APPLIC;A I ION I -OK: To Select from dropbox, click arrow at the end of line
}'KUNOSED IMPKOVLMENN I LOCAL ION:
Address: ` --.._147 Al A4Q/%ILiN i .4
Legal Description:
Lot No.
Property Tax ID #: ����J ��VU�
Block No.
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
IN- I AILED DESCKIP i ION OF WORK:
/y -,r 0Jtc
1,1S. -e( C� P-04` 9,
CONSTRUCTION INFORMATION:
P nh- erormed uncTert ,i permit--cfiec a a
P9l�lI1Wv a�. •. ... .. _—
Gas Tank
❑Gas Piping LJ _Shutters
Electric LJ Plumbing Sprinklers 11 Generator
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
�/ _
Cost of Construction: $ / / �� f Utilities: 0 Sewer 0 Septic
OWNER/LESSEE:
Name' A kInArl Au4tillifI.,-- . -
Address: 0601- 8 0
City: Vi^ State: F
R1
Zip Code: 3 4a8�j Fax:
Phone No. 1Tot 8qq d+g3
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
CONTRACTOR:
Windows/Doors
1-1 Roof = Roof pitch
Building Height:
Name: Gi'�cTA6k0z Cn:;
Cu Gn1 >� �r J St2,tl iru
company:
Address: 14715 �S C i ee rt �� r
City: Po P_T-,St . L v c ; State: r
Zi p Code: +q 5_2 Fax: `77J 3,5-1 c Ic
Phone No. 7'11 23
-335'
-
E -Mail C� etc �r ��s QtI Cc•�n
State or County License:
tf value of construction is $2500 or more, a RECORDED Notice of Commencement is required
ISH
05M
721
30*0
SUPPLEMEN I AL CIONS I RUL I ION LIEN LAW INFORMA 1 ION:
DESIGNER/ENGINEER: Not Applicable `MORTGAGE
COMPANY: _ Not Applicable
Name:
Name:
Address:
I Address:
City: State:
City: State:
Zip: Phone:
I Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City:
City: I
Zap: Phone:
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 conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit 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 follo.ving 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 recording your Notice of Commencement. "
s
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contracior/License Holder
III
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing instrument :was acknowledged before me The forgoing instrument was acknowledged before me
this day ofdii 20 /by this day of 20 by
�-CCfv -ri ja ;1� is ''• -
(Name of person acknowledging } (Name of person acknowledging)
r T •
(Signature of Notary Public- State of F c>.ri,da) (Signature of Notary Public- Stat of Floc" t
111
t,
�� Personally Known OR Produced Identification
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Personally Known OR Produced Identification Y
Type of Identification Produced Type of Identification Produced
Commission No_ L`; ; ' � - - c.. rc aBaDL �$ mission No. 0,1 L!
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Revised 07/15i2014 e' EXPIRES: April 4, 2021
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REVIEWS FRONT ZONING SUPERVISOR 1 PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW l REVIEW REVIEW REVIEW REVIEW i
DATE
'
COMPLETE
INITIALS I
i
ISH
05M
721
30*0