HomeMy WebLinkAboutCCF08192019_00000ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: '�p Permit Number:
ouilioing rermil Applicavon
Planning and Development Services
9uiiding and Code .Regulation Division
2300 Orginia Avenue, Fort Pierce F; 34982 J
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential /
PEKMI I APPLICA I IUN FUR: To Select from dropbox; click arrow at the end of line
PROPOSED IMPRUVEMENI LOCAIIUN:
Address: ,SOSu� 6 f(i Gy
Legal Description:
Property Tax ID #: 7 0- 7 — 7Da 60; 2ZI Lot No.
S'te Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
UE IAILEU UESCRIP i ION OF WORK:
L //IC ror t-lhC- yi"' I'lstre-
CONSTRUCTION INFORMATION:
-Addifi a work- to 6e-erformetl under this perm+- t = chec _aT a abpTy
HVAC 11GasTank FGas Piping Shutters �Windov s/Daars
aElectric ElPumbing Sprinklers Generator L1 Roof R--ofpitch
Total Sq. Ft of Construction: Sq. Ft.
of First Floor:
Cost of Construction: $ 6-Too J Utilities: []Sewer Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Name: C U fc T 1 N rlt r �1 o r'1
Address: fa
q� /(/ a Company: (ut n 7C nt A , (- L u+ 5 t eni s r
City: /�X?Ve � State: f7-- Address: 14715 S E �' l etc - �' r ee i1 I,21 r" i
_ i
Zip Code: Lj0-5" Fax: City: i°07r St • >`. uct State: r-�
Phone No. 77d Zip Code: Fax;
E-Mail: Phone No. `i '1 a 3 3 S- 3 2 3 2
Fill in fee simple Title Holder on next page ( if different E-Mall: C u - + s ti s ct o c [ 0 -
from the Owner listed above) State or County License: Cf. C? (� ( c)
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENIALC:ON51RUCIION LIEN LAW iNFURIVIAIION:
DESIGNERAENGINEER: — Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
i Address:
Address:
City: State:
Ci-b : State:
Zip: Phone:
I Zip: Phone:
t
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDiNG COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City:
City
Zip: Phone:
up: Phone:
i certify that no work or installationhas commenced prior to the issuance of a permit
SL Lucie Counhi makes no representation that is grrnting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bvlal:s orano covenants that may restrict or prohibit such
structure_ Please consult %4-ith your Home O-e ners Association and revie:ti ;your deed for any restrictions ><ihiol may apply_
In consideration of the granting of this requested permit, I do hereby agree that I rill, in all respects, perform the vuork
in accordance •r,ith the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The following building per rRit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures, sMmming pools, fences, tva_ls, signs, screen rooms and accessory uses to another not; -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 with lender or an attorney before
commencing work or recerdingyou r Notice of Commencement.
Si,nature of Cl4,;ner/.essee;Contractor as Alert oer O;:,ter Signature of Contracior,JLicense Holder
i
STATE OF FLORIDA , , ' STATE OF FLORIDA
COUNTY OF _ _ _ COUNTY OF _ -
I
The forgoing instrument was acknowledged before rr=e 1 The forgoing instrument was acknowledged before me
this : 9 day of i this / day of ff , 20 / by
I
(Name of person ackro ,fledging j (Name of person acknot,,ledging )
(Signature of Notary Public- State of F crida ! J i (Signature of Notary Public- State e - cri• = ; '
.
t
Personally Known OR Produced Identification Personally Known OR Produced identification
Type of Identification Produced I Type of Identification Produced
i
Commission No I q`gaD,'Cp CHRISTiNE8E1(}}Imr ission No- r : r` l ` - - �^� ?= - ' • : • = r
MYMMIMISSIONS 3GOM46
w1 .. EXPiRESApril2U21-
"1{R $�S'1[-Lf`}•l_'_.�_
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Revised 0 115i2014 �fc MyCOMMISSION* GGM548
E)TIRES:Apr14, M21
REI.IIE\n!S
FRONT ZONING = SUPERVISOR PLANS VEGETATION
4 SEA TURTLE
MANGROVE I
COUNTER REVIEW REVIEW REVIEIAJ RE\llEVir
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ti=VlEW i
DATE
COMPLE TE
INITIALS
ISH
t1045
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