HomeMy WebLinkAboutCCF09142018_0002ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: Permit Number:
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oum3ing rermn Hppiicavon
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 345182
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
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PEKMI I APPLICA I ION !-OK: To Select from dropbox, click arrow at the end of line
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PK(){'USEL) IMPROV_EMtN i LOCAI ION:
Address:
Legal Description:
Property Tax ID #: �a�� — COOLot No.
a• � � -
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: LeftSide:
131H AILEU L)ESC:KlP I I0N Ot- WUKK:
CONSTRUCTION INFORMATION:
ona wor o e er rme un er is permit — c ec a app
,HVAC Gas Tank []Gas Piping _Shutters F Windows/Doors
11 Electric Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ -7 _ Utilities: 0Sewer F1Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Nam
Address: t (ate i >1 ` i 1�� � i� 1..-
City: Piec� - State•LAddress:
Zip Code: -4,L-P Lj��Z Fax:
Phone No. J U ` -D)
E -Mail:
Name: C U �' z t s LA n,1 ova C e7
Company: _0(.137& M A , r s u s ems n: c,
d -q & ree r1 ��
City: 1pv 2T St • L. u c(f-- State: r�—
Zi p Code: a+q 5Z - Fax
Phone No. Tl Z 3 3:5' 3 3
E -Mail:
State or County License:
_ _
Ril in fee simple Title Holder on next page if different
from the Owner listed above)
If value of construction is $2500 or more, a RECORDED Notice of commencement is required.
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SUPPLEMENIALCONS IRUC11UN LIEN LAW INFORMAIION:
DESIGNER/ENGINEER: Not Applicable
t MORTGAGE COMPANY: _ Not Applicable i
Name:
Name: `
Address:
Address:
City: State:
, City: State:
Zip: Phone:
j Zip: Phone:
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FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: _Not Applicable
Name:
Name:
}
Address:
Address: i
City:
City
Zap: Phone:
Zip: Phone:
I certify that no vvork or installation has commenced prior to the issuance of a permit.
St. Lucie Countv makes no representation that is granting a permit tall 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 vihich may apply.
In consideration of the granting of this requested permit, I do hereby agree that I +..fill, in all respects, perform the work
in accordance Mth 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, s%%imming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
WARN ING 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. -
Signature of Owner/Lessee/Contractor as Agent for O:vner
Signature of Contractor/License Holder
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STATE OF FLORIDA {
STATE OF FLORIDA
COUNTY OF ` ' ` _ !
COUNTY OF
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The for ping instrument :vas acknowledged §efore me
The for ing instrument was acknowledged before me
this day of n�--, 2d b�
this day of :x;'; >� \ 20 ` by
In moi �
� '1 r�?C•
(Name of person acknowledging j
(Name of person acknowledging)
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JPublic-
(Signature of Notary Public -State of Fi a j
1
(Signature of Notary State/of =1p
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification Produced
Type of Identification Produced
Commission No_ U1(it7 �` J ��^ y�
ray. CfiR15TWE8
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r1�rpeq GNrel$?it.K. ? 1
mission No. L"I C1 IX J 1
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Revised 0/15i2014 * mycoemsta; mous
WM.AW114,2121
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REVIEWS FRONT ZONING F SUPERVISOR I PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW # REVIEW REVIEW REVIEW REVIEW i
DATE
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COMPLETE
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INITIALS
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