HomeMy WebLinkAboutCCF06052019_00001ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 6 S �� / Permit Number:
ouiming rerma iAppiicavon
Planning and Development Services
3uilding and Code Regulation Divisior,
2300 Virginia Avenue, Fort Pierce FL 34982 /
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
ft W i I APPUC:A i IUtN FUR: To Select from dropbox, dick arrow at the end of fine
YKi3i'osu) imPK011t_ MEN l LQC;A1ION:
Address: - — �� 0"� /1 _1414 p 411y
i_egal Description: /
Propertv Tax ID r: /7�� bS�` laLot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
i )F i Alt I-u L3E-SCKIP I K3N Oi- WOKK:
L
11(c- I'-r 01te- I r",., lvS"Cu C��r,K 9v� S���i✓
CONSTRUCTION INFORMATION:
t&VAC Gas Tank
Electric Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $
OWNER/LESSEE:
t is permit -check all i� appry:
[]Gas Piping _Shutters
Sprinklers Generator
Sq. Ft. of First Floor: _
Utilities: �11Sewer ElSeptic
1,2164 GriilL,
Address: t� f n rJ V 41.4 z& 4/42
City: Ft P1' e Dec State: FG-
Zip Code: 3lf Qgr1'- Fax:
Phone No. 77;- 40 & 0 75
Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
CONTRACTOR:
LWIndowsjDoors
117 Roof Q Roof pitch
&,,ilding Height
Name:
Ci:ZI�
��rLc;rlcrS
Company:
�- L,t s t a rv�
At e",KS
Address:
' � t 5 � E
1,' 1 i
P— .C= ! L•ct t, State:
Zip Code:
7'tl5Z-
't�fa7 `��-tci
Fax -
Phone No.
l
3 S- 3 L
E-Mail.
t
A.K Stab 5` s t CcnI L&
State or County Ucense:
` f c C i
if value of construction is $2500 or more, a RECORDM Nobce of Carrtmencement is requked.
SUPPLEMEN I AL GUNS 1 RUC I ION LIEN LAND i NLURiV1A I IUN:
DESIGNER/ENGINEER: _ Not Applicable
I MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
' Address:
City; State:
{ City: State:
up: Phone:
Zip: Phone:
I
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name: 1
Address:
Address:
City: i
City:
Zip: Phone:
Zip: Phone:
1 certify that no work or installation leas commenced prior to the issuance of a perriiL
St_ Lucie County makes no representation that is granting a pemtit will authorize the permit holder to build the subject structure
v:hicii is in conflict with any applicable Home Ompers Association rules, b+>lavvs or ano covenants that may restrict or prohibit such
structure- Please consult :vrth your Home Owners Association and reoi w 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 York
in accord ance;!Ath fhe approved plans, the Florida Building Codes and St_ Lude County Amendments.
The follordng building pemtit applications are exemptfrom undergoing a full concurrency review: room additions,
accessory structures, s>.t+immino pools, fences, :.,alls, signs, screen rooms and accessory 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.
f
s i
Signature of Oki,-leri-esseejContrac for as Agent for O::nler
Signature of Contracorlikense Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF _ _
COUNTY OF
i
The forgoing instrument :eras acknowledged before me f
The forgoing instrument was acknowledged before me -
this day of - 20 by I
. I
this �S day of ✓- 20 by
(Name of person acicnc::ledging)
{Name of person acknovAedging )
(Signature of Notary Public -Stag of Fo�rida)
(Signature of Notary Public- State of, Floricza, i
Personally Known OR Produced Identification
f Personally Known OR Produced identification
Type of Identification Produced
Type of Identification Produced_
Commission No- g�Yp CHRISTINEBENt
MY CMIMSION 3
mission No- o
33GO52546 I
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