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Home My WebLink AboutCCF04012019_00000ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Number: • iiuimirig rerma AppiCavon Planning and Development Services Building and Code Regulation Division 2300 Virginia Avenue, Fort Pierce FL 34982' Phone: (772) 462-1553 Fax: (772) 452-1578 Commercial Residential PEKMI I APPLICAI ION FOR: To Select from dropbox, click arrow at the end of line PROPOSE) IMPIfOVEMEN I LOCAI ION: Address: Legal Description: Property Tax ID #: t�,�a�i' S ©�`Ql�� C7 Lot No. Site Plan Name: Block No. Project Name: _ Setbacks Front Back: Right Side: Left Side: UE I AILED DESCRIP i ION OF WOKK: sgsr�n � Lth� �� [.Ike 1.T-� /s's�� c��►xsc o� S" CONSTRUCTION INFORMATION: -Addifi— a,vwor to e er ormed under PH�VAC Gas Tank Electric Plumbing Tota; Sq. Ft of Construction: Cost of Construction: $ .7 �0 OWNER/LESSEE: this permit - cnecK ailapply. [_]Gas Piping _Shutters Sprinklers 0 Generator Sq. Ft. of First Floor: Utilities: 0 Sewer 0 Septic Name d Y;l,& .S fr�J�iX�nrJ Address: /FJ� D �[s L` /1z city: �,� BS'E �°�1 �� State: F�- Zip Code: Fax: Phone No. '4 �O E -Mail: 1,4f 7 i "/C/ Ir Fill in fee simple Title Holder on next page ( if different from the Owner listed above) L1Windows/Doors LlRoof Roof pitch Building Height: CONTRACTOR: Name: CUV9,TIS Sh(IA0AC(I r Company: C; (,k To nt / k c- L4 s t e%KS Address: 114715 S E1 �; l 1 dG �� r ee a City: C P -T .St . C uci State: r� Zip Code: 13 +q 5-2 - Fax Phone No. ` I I 336_-L-31 E -Mail: C u S t Q n I C b rfti State or County License: i✓ Ci 5 it E 1 C' If value of construction is $2500 or more, a RECORDED Notice of Commencement is required. SUPPLEMENIALCONS IRUCIION LIEN LAW INEORMAIION: DESIGNER/ENGINEER: Not Applicable I MORTGAGE COMPANY: _ Not Applicable Name: Name: Address.: Address: 1 City: State: City: State: Zip: Phone: i Zip: Phone: FEE SiMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: Not Applicable Name: Name: Address: I Address: City: City: I Tip: Phone: Zip: Phone: I certify that no vrork or installation has commenced prior to the issuance of a permit_ St. Lucie County makes no representation that is jrnting a permitr:ili authorize the permit holder to build the subject structure which is in conflict with any applicable Home Osiners 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, l do hereby agree that t will, in all respects, perform the eaork in accordance Mth the approved plans, the Florida Building Codes and St- Lucie County Amendments. The folior:ing building permit applications are exemptfrom undergoing a full concurrency review: room additions, accessory structures, swimming pools, fences, twa=1s, 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 fo r 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 OEiner/-essee/ Contractor as Agent for O%vner Signature of Contracor/License Holder I STATE OF FLORIDA STATE OF FLORIDA COUNTY OF COUNTY OF = - The forgoing instrument ;ras acknowledged before me The forgoing instrument was acknoveledged before me this day of 20, _-by l this /day of r//, 1W by � (Name of person ackncr:ledging ) (Name of person acknowledging) (Signature of Notary Public- State o f- crl a) (Signature of Notary Public -State o"i : lori6F } Personally Known OR Produced Identification Personally Known OR Produced Identification Type of Identification Produced Type of identification Produced I - ')VP No. ' nuss�on No_ 6� 7_ . . - •, _ } Commission • ' . _ _, ig0a�, * MYCOMSSIONs J�A3 t7ADr� .�2t _ ��ortti°�' am�°1n"'eu�rar�yse�s i .-"�- Re�°isedG:/1�/?G1 MYCoK�#GGA °� EXPIRES:AprB4,�l `oma i REVIEWS FRONT ZONING SUPERVISOR' PLANS ` VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW I REVIEW REVIEW REVIEW REVIEW DATE COMPLETE I INITIALS I