HomeMy WebLinkAboutCCF06182018_00002ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
j Permit Number:
Date:
15miaing rerml>c HpPlicai>ton
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort pierce FL 342 Commercial __. Residential _
Phone: (772) 462-1553 Fax: (772) 46-1578
PEKMI I APPLIC:A I ION FOR: To Select from dropbox, click arrow at the end of line
I'KOI'OSEU IMPKOVEMEN I L( -)CAI ION:
Address:
Legal Description:
Lot No..
Property Tax ID #: - Block No.
Site Plan Name:
Project Name: Back: Right Side:
Left Side:
Setbacks Front
_—
DE I AILED UESCKIP I ION Ol- WOKK:
<<r ClA
(,llz
CONSTRUCTION INFORMATION_ .,o.K,t -
H40I110f1e" wvl � �� �� U Shutters
L.JHVAC Gas Tank Piping
Electric Plumbing Sprinklers Generator
Total Sq. Ft of Construction:
Sq. Ft. of First Floor: _
j no utilities: []Sewer[] Septic
Cost of Construction: $
OWNER/LESSEE:
Name //C �"
Address: ��✓�� N /�
City �7`L'YU �i� i /d �� .,,A State:
Zip Code: �i1� Fax:
Phone No. gee` -S 7zlC
E-mail:
FII in fee simple Title Holder on next page (!I different
from the owner listed above)
CONTRACTOR:
FWindows/Doors
0 Roof Roof pitch
Building Height: ___-__—
i
Name: CU�CT(S Nhlati�cn�
Company: C�l��aot s s
est s
t lr l 5 r ee i1
Address:
PO 2r St . L c e- State: 1 c-
C�'
Zip Code: `FRFax 77?- .35- i 1
SE ;
Tia- 33Phone No.
5
E -Mail: u S t a i r S Co
State or County License: G o 519 10
a RECORDED Notice of Commencement is required.
if value of construction is $2500 or more,
I AL CONS I RUL I [ON LIEN LAW IN FUHMA I ION:
SUPPLEM EN
Not Applicable MORTGAGE COMPANY: Not Applicable
DESIGNER/ENGINEER:
_
Name:
Name:
Address:
Address:
State: _
City:
state: += Citi
; Zip: Phone:
Zip: Phone:
i —
Applicable BONDING COMPANY: Not Applicable
Not App
FEE SIMPLE TITLE HOLDER:
_
Name:
Name:
Address:
Address:
City:
City:Z
p; 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 subjectsi structure
w. sicloak wnsh all ithppli applicable
Oe Ow er so tion andion rules
rev e:I`your deed or any restrictions coveriants wrestrict
ich m oa prohibit such
structure.
In consideration of the granting of this requested permit, I do hereby agree that 1 will, in all respells, perform the work
in accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The folio.�Ving building permit applications are exempt from undergoing a full concurrency review: room additions,
derg
accessory structures, swimming pools, fences, %-.ra`ls, signs, screen rooms and accessenr uses to another non residential use
in
our
WARNING TO OWNER: Your failure A Nonce of Commencement rmust be recordedencement atnd postpaying
d o g twice
ijobsnite
improvements to your property. rty
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.
Signature of 0tmer/ essee/Contractor as Agent for G. j Signature of Contracfor/License Holder
STATE OF FLORIDA
COUNTY OF
The forgoing instrument +.vas acknowledged before me
this /' ' day of �4h-20 —b` -
(Name of person acknowledging !
(Signature of Notary Public- Stateof F;q�a)
Personally Known OR Produced Identification
Type of Identification Produced_
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before n.e
this day of 'o _by
c'
0 t11 11 Fac n
(Name of person acknowledging)
(Signature of Notary Public- Stat of Eloriada
Personally Known ' OR Produced Identification
Type of Identification Produced
Commission No_ (h 610 t)2,S ��� ?q��:t�
CHRISTINE
* MY COMMISSION l� iGG 0525dG6
*op.7.
MRES_Aprd }, 2021
�c 3ar�tleG Ttw Budget Natm Services
Revised 0 7 /'1-:; i2014
REVIEWS TRONESUPERVISOR
NS
COUNER EW REVIEW REVIEW
DATE
COMPLE T E
INITIALS
* MY COMMISSION ! GG 052566
EXPIRES: April 4, 2021
•- ' l� 05256
VEGETATION SEATURTLE I IVIANGROVE
REVIEW REVIEW REVIEW