HomeMy WebLinkAboutCCF07112019_00000ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: %-/l `��. Permit Number:
r ! i
ouiming rermn Hpp icavon
PJannirg and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce Ft 34982
Phone: (772) 462-1553 Fax: (772) 462-1_578 Commercial Residential r
PEKMI I APPLICA I IUN FUR: To Select from dropbox, click arrow at the end of line
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YROPOSEU IMPROVEMENI LUCAIION:
Address:
Legal Description:
Property Tax ID #: LFZI 66— 6 6 4�' �// /' �i�i� —� Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
UE I AILED UESCK/1I,P I ION OF WORK:
e ��or LlKt �J �S) /Pee- ���i�jt. ✓i ���(it0
CONSTRUCTION INFORMATION:
Aa itigna wor to oe ocrformed under this permit — check 0_ apply:
allVAC QGasTank ]Gas Piping Shutters �Windovv5/Doors
Electric Plumbing FISprinkiers Generator Roof Roof pitch
Totai Sq. Ft of Construction: Sq. Ft, of First Floor:
Cost Construction: $ ���� Utilities: []Sewer
of Septic Building Height:
OWNERAESSEE: CONTRACTOR:
Name L'hrls/122 0'rol7lull
Name: LCrr-TI SA(Lli,31cn5
Address: 57/ ztz' 5GG�
i Company: C t l r,-T6 of A ur S t eVYt S l ni r:
City: /kc'2ccCcc /fL State: FL
{ Address: 14715 S E �,�; l *1 etc,-'e �(r~vei-k
Zip Code: ��IFJ�� Fax:
, city: �c' T St • L vci State -
Phone No. d 01"r-- h�-�
! Zip Code: ' `fg52- Fax 7T2. s
E-Mail: c C C ,Ci
Phone No. 35-
E-Mail: { t t•_ i r s y s p Cc C
Fill in fee simple Title Holder on next page { if different
State or County License: C 4 C c 51
from the Owner listed above)
If value of construction is $2500 or more, a RECORDED Notice of
Commencement is required.
SUPPLEMENIALCONSIRUC:IICIN'-LIEN LAW INFORMAIION:
DESIGNER/ ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone:
i Zip: Phone:
!
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 .vork or installation has commenced prior to the issuance of a permit.
St- Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
v:hich is in conflict witil any applicable Pome Owners Association rules, b�:lafvs or and covenants that may restrict or prohibit such
structure- Please consult vAth your Home Owners Association and revie:v your deed for any restrictions >•ihicii may apply.
In consideration of the granting of this requested permit, I do hereby agree that I :�ili, in all respects, perform the work
in accordance with the approved plans, the Florida Building Codes and St_ Lude County Amendments.
The folioreing building permit applications are exenriptfrom undergoing a full concurency review_ room additions,
accessory structures, stnuirnming pools, fences, %ails, signs, screen roorns and accesson, uses to another non-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/Lessee'Contractor as Agent for O.vner �
Signature of Contrac orf License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF _ _ _
COUNTY OF _
1
The forgoing instrument was acknowledged before me
The forgoing instrument vas acknowledged before me
this day of ,Tu 4- 20 19 bv I
• I
this day of JC,'Z- 20 / by
(Name or person ackro.:ledging
(Name of person acknot:fedgino )
(Signature of Notary Public- Stab of F r -ia j �
(Signature of Notary Public- State of=1or-iae-
Personally Knotivn OR Produced Identification 1
Personally Known OR Produced Identification
Type of identification Produced
Type of Identification Produced i
Commission No_', ': } - q CHR15T1NEBEtitt
e mission No. __ ?_ • ... = r
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