HomeMy WebLinkAboutCCF11102020_0001All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: IL 20 'Zy Permit Number:
•
Planning and Development Services
Building and Code Regulation Division
2.300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Building Permit. Application
Commercial `/ Residential
PERMIT TYPE:
PROPOSED 1WR0/E IE -
Address: -C�
V1 r
.. z
Additional work to be performed under this permit —check all that apply:
`iVlechanical — Gas Tank _ Gas Piping _ Shutters Windows/Doors
_ Electric ___. Plumbing _ Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ 3`0 5
_ Generator _ Roof Pitch
Sq. Ft. of First floor:
Utilities: —Sewer _Septic Building Height:
OWNERAESSEE: _.
Namr�
e
Name: Curtis Sammons
Ads:
Company: Custom Air Systems, Inc.
City:OC'�- Q_State:
Address: 1615 SE Village Green Drive
Zip Code:Fax:
City: Port Saint Lucie State: FL
Phone No.9 1 a -- 8ri3 J Os [is
Zip Code: 34952 Fax: 772-335-1968
E -Mail:
Phone No 772-335-3232
Fill in fee simple Title Holder on next page (if different
I E -Mail custairsys@aol.com
from the Owner listed above)
i State or County License CAC051810
IT vawe or construcuon is 4o1buu or more, a RECORDED Notice of Commencement is required.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: _Not Applicable
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated_
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no representation that is granting a permit will authorize thepermit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners Association and review 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 work
in accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory 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 JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WFM YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signature of Owner/ Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
this +'Q day of LNefY1),;QC , 20_/u by
STATE OF FLORIDA
COUNTY OF tit 9ueL
The forgoing instrument was acknowledged before me
this 1O dayof KlbC ILm,U2 20ZQby
Name of person making statement. Name of person making statement.
Personally Known �_ OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
MAP
Ma -A �W__
(Signature of Notary Public- State of Florida )
4 2o�Y ova CHRISTINE B ENI
ly
Commission No.:2i1i v+<3 `�i� * L MYCOWISSIONBG
�4 ,07 EXPIRES:AP44.
REVIEWS I FRONTZONING
COUNTER REVIEW
DATE
RECEIVED
DATE
COMPLETED
(Signature of Notary Public -State of Florio-,ta
CHRISTINE SEI
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mission No. MYCCW.NSSION#
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Septre r 28, 2020
NAMS: PE'R"CT DRXVE GOLF VT
AmRs Ss
PHOM : 873-05 .5
FAX; 873-0445
SALES * SERVICE * INSTALLATION * A"LIANCES
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