HomeMy WebLinkAboutCCF06032019_00000ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 6 -, -i f Permit Number:
ouiltaing rerma App[tcavon
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-2553 Fax: (772) 462-1578 Commercial Residential
PEKMI I APPLIC;A I ION l-QK: To Select from dropbox, dick arrow at the end of fine i
PROPOSED IMPKOVEMt_N I LOCAI ION:
Address: - — �d�0 (*d 44 m k rt /'iGL
Legal Description:
Property T:'ax tD r: J``1,2 S' ?,D,Z "00 7.S--g04D 'L5J Lot No.
Site Plan Name:
Project Name:
Setbacks Front Back:
UE I AIL;_U UESCKi!' I ION 01- WOKK:
Right Side: Left Side:
L llte- e r 0ke. Z •� .��... lysee-r Ck&Y%s c- oa< 75-fl `
CONSTRUCTION INFORMATION:
A a a �vo o oe oe rme un er t its permit-
OVAC [3 Gas Tank []Gas Piping
ElE1ectric I:j Plumbing []Sphn€Jers
Block No.
tn_al aPPry:
Shutters FWindowslDoors
ElGenerator +..�1 Roof
Total Sq. Ft of Construction: (/ Sq. Ft. of First Floor:
Cost of Construction: $ / �� Utilities: lllSewer7Septic
OWNER/ LESSEE:
Na
i9
Address: J 0'O c 01CeM4rinct� L►r
City: FO Sr ST k uc t'-e. State: �L
Zip Code: 3 4g5'a- Fax:
Phone No.
E-Mai(:
RH in fee simple Title Holder on next page ( if different
from the Owner listed above)
CONTRACTOR:
Name:
Building Height
Roof pitch
Company: US7anti A , c- 5u 5.tey;"s
Address: ilYtS 1f ti da �_�S eeit C
' may: t o f_r St. L ucc Ie, State:
c_,ct l<-c
� Zip Code: u�f-45:Z- Faye '►`T�- =
fPhone No. '7 " l %1 ,3 3 S - 1-
E-Mail: i ALkStcz',r 5�5,= Cco1 CGr/L
State or County License: G' J i E ( C
if value of construction is $2500 or more, a RECORD Notice of Comnsencement is required.
SUPPLEMENIALC;UNSIRUC I[ON LIEN LAW INFURMAIION:
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable i
Name:
j Name:
Address:
Address:
City: State:
City: State:
Zip: Phone:
Zip: Phone:
i
FEE SIMPLE TITLE HOLDER: Not Applicable
' BONDING COMPANY: Not Applicable
Name:
Name:
Address:
Address_ i
City:
City -
Zip: 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 kvill authorize the permit holder to build the subject structure
which is in conflict with any applicable }-some Owners Association rules, by -la- ws or ano covenants that may restrict or prohibit such
structure_ Please consult :-itch your Home Owners Association and re%re.-j your deed for any restrictions which may apply-_
In consideration of the granting of this requested permit, I do hereby agree that 1 will, in all respects, perform. the work
in accordance oath the approved plans, the Florida Building Codes and St_ Lucie County Amendments_
The folloving building permit applications are eaen-ptfrom undergoing a full concurency review: room additions,
accessory structures, sLmmming pool, fences, :.,a'ls, signs, screen rooms and accesseR, uses to another nor, -residential use
WARNING 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[ essee,'Contractor as Agent for O'.vner !
Sig -nature of ContracorfLicense Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF _ = �• ;
i
The forgoing instrument �.-ias acknowledgeed before me j
The forgoing instrument was acknowledged before me
this day of 2d i by I
this day of t� 20 by
I
,
(Name of person acknoi.ledging) '•
(Name of person acknc: fledging) i
(Signature of Notary Public- State of i-cri^a) `(
1
(Signature of Notary Public- State of F loric. ,i
i
Personally Knowri -' OR Produced Identification
Personally Known OR Produced identification
Type of Identification Produced
Type of Identification Produced
CH
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