HomeMy WebLinkAboutCCF03212019ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: _6- L C.� Permit Number:
ouiming rermn i►ppncaxion
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 345182
Phone: (772) 402-1553 Fax: (772) 462-1578 Commercial Residential
FERMI I APPLICA I IUN FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMEN I LOCAI ION:
Address: �Jg-�uC�0C1.. kC% "� r
Legal Description:
Property Tax ID ##: 3 (O(Oq - " Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DE I AILED DESCRii' I ION OF WORK:
CIA hfG �-�
CONSTRUCTION INFORMATION:
Additoatworkto e er ormed un erT this perm t - checka appy:
HVAC Gas Tank as Piping _ Shutters F Windows/Doors
11 Electric Plumbing Sprinklers 7 Generator F]Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
�� 6�"� Utilities: O Sewer 7 Septic Building Height:
Cost of Construction: $
OWNER/LESSEE:
CONTRACTOR:
—�
Name Trrede+',r�, P�laOMi�FGt'�t 4G ci-2cfD
Name: Ci' �ENrLeo"lcr�S
Company: nvt A S,_i S
Address:
City: Civ e042Of l State:.=
Address: 1 15 E ree a tD
ZipCode:SZgb�0 Fax:
City: (�G2T Sr. Loci State: r�-
Phone No.S(03 - sb�5 - ;5oq�
Zip Code: Z_+g5)-- Fax: `7 7�?-
E-Mail:
Phone No. Tia, 335- - 3
Fill in fee simple Title Holder on next page ( if different
E-Mail: C' u a t c- t S ti s Cc o t c awl
from the Owner listed above}
State or County License;
Commencement is required.
tf value of construction is $2500 or more, a RECORDED Motice of
SUPPLEMEN IALC:UNS I RUC IION' ILN LAUD INFORMAI IUN.
DESIGN ER/ENGINEER- Not Applicable
I MORTGAGE COMPANY: Not Applicable
Name:
_
Name:
Address:
Address:
City: State:
City: Smote:
Zip: Phone:
I Zip: Phone:
i
FEE SIMPLE TITLE HOLDER: — Not Applicable
BONDING COMPANY: Not Applicable i
Name:
Name:
Address:
Address: l
City:
City:
Zip: Phone:
up: 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
f, hi h is in conflict with any applicable Nome Oa:�r.ers Association rules, by-laws or and covenants that may restrict or prohibit such
structure_ Please consult :•lith your Home Owners Association and revie_•z 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 vrith the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The folimt1ing building per n it applications are exen.ptfrom undergoing a full concurrency review_ room additions,
accessory structures, s417mming pools, fences, :«ails, signs, screen rooms and accessory uses to another non-residenrai 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/LesseejContractor as Agent f or Owner Sip ature of Contrac or Ucense Holder
STATE OF FLORIDA STATE OF FLORIDA ,',f
COUNTY OF COUNTY OF
I
The forgoing rargoing instrument _s acknowledged before me The forgoing instrument was acknowledged before n,e
tllis,>� dayoff_Qr rCL br I this day of r i(h('Cly ,20 by
J I
(Name of person acknowledging) � (Name of person acknokviedging )
(Signature of Notary Public- State of F cr,_:a) (Sig«ature of Notary Public -State o. Imo, k.
i
i
Personally Knoitm OR Produced Identification Personally Knovvn Oct Produced Identification
Type of IdentRication Produced Type of Identification Produced
Commission No. -i fii t i c ga'; CH RISTINEBENWftnlission No.
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MYC4MMMION3052546
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R!1'CEXPIRES:
Revised 07/1-'V2014
A; O44,2002512aC�i
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