HomeMy WebLinkAboutCCF07082019_00000ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: %d l-f Permit Number:
•
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue. Fart Pierce F! 34982 11
Phone: (772) 462-1553 Fax: (772) 462-'578 Commercial Residential G
PEKMI I APPLICA I ION FOR: To Select from dropbox, click arrow at the end of line
NKUPUSED IMPRUVEMEN I LUCA I ION:
Address: ��a /�-d-�im `ZU.21✓
Legal Description:
Property Tax ID jlla2 7241,9 -CK5Y-CW7 6. Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DE I AILED DESCK/IP I ION OF WORK: r i < !,
CONSTRUCTION INFORMATION:
Additional wo-r to be berformed under #his permit- cFec�c , an Iv.-
HVAC 71 Gas Tank ❑Gas Piping Shutters 1_11'.Nindows/Doors
Electric F1 Plumbing OSprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: S J b Utilities: E]Sewer D Septic Building Height:
OWNERAESSEE: 'CONTRACTOR:
Name eagle 2clli_ZPtt — Name: I<THa o,\Cn"
Address: .��•2 i /�a�c �4n�,�G� Company: Lr,--ro ni A• � ��i 5 � eV�IS
1 city: State: FL Address: I - (5 S E �/l 1 I dG -e �� r ee rn
Zip Code: Fax: City:(U ✓ T- ,St . L uct f— State:
��9�3 �
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Phone No. SSA- 3 f%l- �a7C ' Zip Code: `(-qSZ Fax: 77�' 3�5-1 q (rr,
E-Mail: Phone No. T1 a. 3 3 S- 3.2 3
Fill in fee simple Title Holder on next page { if different E-Mail: C u 5 t cti t r C Cr o
from the Owner listed above) State or County License: G C' S i 5i 10
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If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENIALCONSIRUCIION LIEN LAW INFURMAIIUN:
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
Name:
Address:
II Address:
City: State:
I Cifi/: State:
Zip: Phone:
i Zip: Phone:
i _
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name: j
Address:
Address:
i
city,
City:
Zip: Phone:
up: Phone:
I certify that no .pork or installation inns commenced prior to the issuance of a permit_
St_ Lucie Countv makes no representation that is granting a permit will authorize the permit holder to build the subject structure
v.hich is in conflict with any applicable home O.:rner s Assocration rules ,v b.-lawns or and covenants that may restrict or prohibit such
.trictions which may apply.
structure- Please consultvHomedh your ome Ov nersAssociation and retie.your deed for any res
In consideration of the granting of this requested permit, I do hereby agree that ► :tilt, in all respects, perform the work
in accordance v ith the approved plans, the Florida Building Codes and St- Luce County Amendments -
The following building permit applications are exemptfrem undergoing a full concurency review: room additions,
accessory structures, sainim- ing pools, fences, :tails, signs, screen rooms and accessory uses to another nor -residential use
WARN iNG TO OWNER: Your failure to Record a Notice of Commencement may result in your paying twice for
improvements to your properly. A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection- If you intend to obtain financing, consult varith lender or an attorney before
commencing work or recording your Notice of Commencement.
i
s
Signature of Ownerj-essee'Contractor as Agent for O;vner !
Signature of Contrac:orf License Holder
STATE OF FLORIDA (
STATE OF FLORIDA
COUNTY OF _
COUNTY OF -
l
t
The forgoing instrument ."vas acknowledged before me =The
forgoing instrument.was acknouiedoed before me
9
!his f day of q"�y 20 9 by 1
this tf day of , 20 / by
i
J
(Name of person ackrc'� fledging) i
(Name of person acknov:(edging)
(Signature of Notary Public- Stir_
(Signature of Notary Public- State o . i-= ,
Personally Known '� OR Produced Identification
I Personally Krowfn OR Produced Identification
Type of IdentiTccano -Produced
;
Type of Identification Produced134,
'�a( CHRISTINEBENGVftmission
Commission No _- �.tKb
No. L7,
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FRONT ZONING SUPERVISOR PLANS VEGETA T 1ON I
SEA TURTLE
iV1.ANGROVE � `
COUNTER REVIEW ; REVIEW i REVIEW REVIEW
REVIEW
REVIEW
DATE
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COMPLETE
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