HomeMy WebLinkAboutCCF06182018_00000ALL APPLICABLE MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
INFO
Date: 10 Y0 Permit Number:
r3miaing rermli App icavon
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34992
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PEKMi I APPLIC:A I ION FOR: To Select from dropbox, click arrow at the end of line
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PROPOSED IMl'KUVI=MEN I LOCAI ION:
Address:
Legal Description:
Property Tax ID #: V Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DE I AILED DESCKIP I ION OF WORK:
CT✓
CONSTRUCTION INFORMATION:
qna wor o e er rme under this permit -check all apply:
HVAC Gas Tank []Gas Piping _ Shutters Q Windows/Doors
11 Electric Plumbing Sprinklers Generator Ll Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
I e' C;� n
Cost of Construction: $ / S'Utilities: �,�.! Sewer _ Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
,
Nameac.
Name: C is VC T 1 S ,Sp tit yV\ e n
Address: iiCC�d' �� %7�a ,�v
Company: Torvt A
City: �o �t� State: F`-
Address: [ l 5 i/� l dG �( r ee i l
City: Pv I;LT ,St (_. uc( c-, State -
Zip Code: Fax: 77.� -fly /2 76
Phone No.
Zip Code: bi+q - Fax: `77,? J -3 5-19
E-Mail:
Phone No. 114- 3 3 S- 3 2- 32-
2FII
E-Mail: u
R11 in fee simple Title Holder on next page { if different
State or County License: Ct C O 5 [
from the Owner listed above)
ff value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
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SUPPLEMENIALGUNSIRUC I[ON LIEN LAW INFURMAIIUN:
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: Applicable
Name:
_Not
Name:
Address:
Address: l
City:
City: i
Zip: Phone:
Z-1 p: 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 Hone Ot:hers Association and revie:v your deed for any restrictions tahich may apply.
In consideration of the granting of this requested permit, I do hereby agree that 1 will, in all respects, perform the t:ork
in accordance with the approved pians, the Florida Building Codes and St. Lucie County Amendments.
The follor.ling building permit applications are exemptfrom undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, va`ls, signs, screen rooms and accesser\ 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.
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Signature of Owner/Lessee; Contractor as Agent for O:vner
Signature of Contractor/License Halder
STATE OF FLORIDA : ; , j
STATE OF FLORIDA r, .
COUNTY OF is
COUNTY OF
The forgoing instrument was acknowledged before me ;The
forgoing instrument was acknowledged before me l
Thisi 'day of 20 b
I
thisday of 20 by l
�r►c,i7 S'
i
c c.c ( rl S r� trl Fac n S
(Name of person acknowledging } (
(Name of person acknowledging }
•iL '�"L Z.l�f�-L �—i:.-��� , i /L I
�� r L''1•ldi�.' . =•:J � : i!� I
(signature of Notary Public- State of F±or _ a
(Signature of Notary Public- Stat of Flo
Personally Known ✓ OR Produced Identification
Personally Known '� OR Produced Identification
Type of identification Produced i
Type of Identification Produced
Commission No. 61 6.7 5'� J 71✓ Y"�t CHRISTINEBEN%@Hlmission
No.
ria
MY COMMISSION X GG
EXPIRES April,
052146
• ' —
0/ f b4 BoMed Tivu Budget Not2N
_
Re-vised 07/15i2014
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Services B ENGLISH-
* * MY COMMISSIONS GG 052548
ExaIRES: April a, 2021
Bowel
PLANS VEGETATION SEA TURTLE MANGROVE
REVIEWS
—
FRONT ZONING ` SUPERVISOR
COUNTER REVIEW I REVIEW i
REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
i
INITIALS - -
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