HomeMy WebLinkAboutCCF04022019_000001 UE I AILED UESCKIP I ION Ul'- WOKK:
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CONSTRUCTION INFORMATION:
rid i a wor to be oe orme un er t is permit — c'heckall
HVAC ❑Gas Piping
app :
Shutters []Windows/€?oors
Gas Tank
_
Electric Plumbing Sprinklers
ElGenerator Roof Roof pitch
Tota; Sq. Ftof Construction: Sq. Ft. of First Floor:
ElSewerElSeptic
Cost of Construction: Utilities:
Building Height:
OWNER/LESSEE:— ------ - —
CONTRACTOR:
Name 'in%
!Name: C U ►4'T t �CFt ak0AC (1 5
Address: /
Company: OuS-ant A r �u 5_t i n �,—
City: 'W akp_ 96A_a�tate: /�%G
Address: i 4215 -.e �&,ee r1
Zip Code: a_7S F 7 Fax:
City: F07T St • L v cot_ State- R—
Phone No. �7a 873 D S l�
Zip Code: 3-`{',7571- Fax: 77J2 � 3S -i
E -Mail:
I Phone No. 33 S - 3
Fill in fee simple TitJe Holder on next page( if different
E -Mail: C u s t a i f- s ti 5 4:-- Cr, o i c t. 01-
rnfrom
fromthe Owner listed above)
State or County License:
if value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
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SUPPLEMEN IALC:UNS i RUC IION LIEN LAW INFURMA1ION:
DESIGNER/ENGINEER- _ Not Applicable
I MORTGAGE COMPANY: Not Applicable
Name:
; Name:
Address:
Address:
City: State:
City: State:
Zip: Phone:
Zip: Phone:
FEE SiMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name: ;
Address:
Address: t
City:
CI
Zip: Phone:
up: Phone:
I certify that no work or installation z1as commenced prior to the issuance of a permit
St. Lucie County makes no representation that is jrnting a permit, ilt authorize the permit holder to build the subject structure
which is in conflict with any applicable Pome O.•.rers Association rules, by- laws or anct covenants that may restrict or prohibit such
structure. Please consult .v!th your Home Otimers Associ<tion and review your deed for any restrictions which may apply -
In consideration of the granting of this requested permit, I do hereby agree that 1.4jill, in all respects, perform the v-Grk
in accordance vAth the approved pians, the Florida Building Codes and St- Luce County Amendments.
The foliorling building permit applications are exen:ptfrom undergoing a full concurrency review: room additions,
accessory structures, s.vimming pools, fences, : 0s, signs, screen rooms and accessoR, 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.
Signature of Ownerl-essee/contractLor as Agent for O:vner !
Signature of ContraccorlLicense Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF
I
The forgoing instrument .vas acknowledged before me 1
The forgoing instrument was acknowledged before ire
this day of ' " 20 iybr j
- l
this -day of.. 20 by
I
(Name or person ackno,.Lledgmg )
(Name of person acknot:ledgrng )
(Signature of Notary Public- State or Ferir:a ) {
(Signature of Notary Public -State of : loris
1
Personally Krro.yn OR Produced lcientif cation
Personally Known OR Produced Identification
Type of (dentificatien Produced
Type of Identification Produced
Commission No_ - ';g CkRISTWEBENL
MY COMMISSION 3
thmission No_
G 052546
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'siry Suvirrs ZO .• ��pM
MYCOl4iMiSSi0N#GG052.-43
Revised 07/1-:V2014
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T��! lJ(RIRES: W 4.20'11
REVIEWS
FRONT ZONING l SUPERVISOR I PLANS VEGETATION
SEA TURTLE
MANGROVE �
COUNTER REVIEW REVIEW I REVIEW REVIEW
REVIEW
REVIEW
DATE
;
COMPLETE
INITIALS
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