HomeMy WebLinkAboutCCF07312019_0006ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 3 I ` 1
Permit Number:
s
ouijuing rermit Hpplucavon
Mmining and Development Services
Building and Code .Regu,"aiion. Division
2300 Orginia Avenue, Fort Pierce Ft 34982
Phone: (772) 462-1553 Fax: (772) 462-=578 Commercial Residential
PEKMI 1 APPLIC;A I IUN FOR: To Select from dropbox, click arrow at the end of line
PRUYUSEU IMPROVEMEN I LUC:A 1 ION:
Address: 3 (�� C'r'. r� �O•P`P e.
Legal Description::
Property Tax ID #i: 3t-i�5 " r%O� Q� �a — - Lot No.
Site Plan Name: Black No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
UEIAILEU UESCKIPIION OF WORK:
IT-
G.
CONSTRUCTION INFORMATION:
-Addifi-g4al work to ne-.oe�orrried-under this permit - cT�eck aTl� app-Ty: ---
--
HVAC ,� Gas T ank ❑Gas Piping Shutters windows/Doors
1-1 Electric 0 Plumbing Sprinklers El Generator Roof Rccf pitch
Tota Sq. Ft of Construction: _ Sq. Ft. of First Floor:
Cost of Construction: $ �`�S I Utilities F ]Sewer Septic Building Height:
OWNER/LESSEE: + CONTRACTOR:
Name �lV��ni U t'tL)� �, .i Name: 6U c ,S6LPYNcn� --- i cT1�
Address:=��, ii� �� �� j Company: CtLr,-Toni A r sea 5 tems ( rile
State: Address'C(ree 11
Zip Code: Fax: City: t O (zT gt . L uc(,,.- J State: rr—
Phone No. '� 701 a.\ C) (C�51I Zip Code: 13-IK 1- Fax 73 5-1 ci �n 6
E-Mail: Phone No.
Fill in fee simple Title Holder on next page if different E-Mail: Cu a t
from the Owner listed above) State or County License: G' 51 (0
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEM EN I AL DONS I RUC I ION -'LIEN LAW i NEURMA 1 !t)i`d:
DESlGlIiERjENGINEER: ___ Not Applicable
i MORTGAGE COMPANY Not Applicable
Name:
_
Name:
Address:
Address:
City: State:
, City: State:
Zip: Phone:
l Zip: Phone:
i !
FEE SIMPLE TITLE HOLDER: _ Not applicable
BONDING COMPANY: Not Applicable
Name:
Dame: i
Address:
Address:
City:
City:
Zip: Phone:
up: Phone:
i certify that no v.rork or installation :gas commenced prior to the issuance of a permit_
St_ Lucie Count, makes no representation that is granting a permit rill authorize the permit holder to build the subject structure
a:hich is in conflict with any applicable Home Others Assocration rules, b;=lat s or and covenants that may restrict or prohibit such
structure- Please consult tvzth your Home Ov ners Association and revletl your deed for any restrictions vjhich may apply"
in consideration of the granting of this requested permit, I do hereby agree that I .gill, in all respects, perform the v.ork
in accordance �!Ath the approved plans, the Florida Building Codes and St_ Lucie County- Amendments.
The follov; rig building permit applications are ekemptfrom undergoing a full concur-ency reviety: room additions,
accessory structures, stu4mming pools, fences, tea ls, signs, screen rooms and accessory uses to another non-residential use
WARN ING 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 iarith lender or an attorney before
commencing work or reco"ding your Notice of Commencement.
Sio ature of Contractor/License Holder
Signature of OEAnerf essee'CantrauLor 2s Auer. tfor O<:•ner '
t
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF -_---- -
i
The forgoing instrumee .-1as acknovAedged before me 11
this day ,1��
The forgoing instrum nt tvas acknot• ,edged fore me
of �/ 2t7 �br ;
this day of V� 20 by
17
(Name of Gerson ackrcv:ledging) I
I
(Name of person ackno,&Iedging )
_ i
(5ignature of Notary Public- State of Flaoa ) I
(Signature of Notary Public State c- n _
Personally Knotvn OR Produced Identification
Personally Krovrn OR Produced Identification
Type of Identification Produced
Type of Identification Produced
Commission No. - CHRISiU1c8ENeMffimission
is
No. _ �,.` 4" r,". , = r a
2q�a�,
MYCOMMiSSIONS
eDCPfiiES.{1Drd
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GOSMS t I
2021
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WIRES:AprIl4,2i12r
REVIEWS
FRONT ZONING SUPERVISOR i PLANS 'VEGETATION
i SEA TURTLE
MANGROVE �
COUNTER REVIE%N REViEW REVIEW REVIEW
I REViE`!V
REVIEU\°
DATE
'
CO iVl P LETE
! 1
INITIALS
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