HomeMy WebLinkAboutCCF_000186.pdfAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: i ( t k (Z z Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial
PERMIT TYPE: f,I 4 r—"-) „j
Residential
Address: t 1 `1 01"z_2•1 C 4l.11er:"\ell CA —_
Property Tax ID #: _I q 40,) 001 S-
Site Plan Name:
Project Name:
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1"✓ MER
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Lot No. C
Block No. 'Pa
Additional work to be performed under this permit — check all that apply:
_Mechanical e_Gas Tank _ Gas Piping _ Shutters Windows/Doors
Electric `// Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ \ � � L �' Utilities: _ Sewer _ Septic Building Height:
Name f" �t-Yi Sp nc�L
Address: %t!.J��.,�e Cr..IL �T:rat c�
City: FT . R F (cc, State: R
Zip Code: '3Liq `l`i Fax:
Phone No.
E-Mail: c r ei o1u ^s`J ,,q C( lQ>_
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
CONTRACTOR: a
Name: G'__
Company: (Zz e l °io n b: f
Address:
City: ?. ri (✓ State: r L
Zip Code: 3H`1 r } Fax:
Phone No
E-Mail
j State or County License C't 3 l i<
If value of construction is $2500 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.
DESIGNER/ENGINEER:
Not Applicable
illn
MORTGAGE COMPANY: Not Applicable
Name:
_
Name:
Address:
Address:
City:
State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Not Applicable
BONDING COMPANY: Not Applicable
Name:
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 the permit 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.
Inconsideration of the granting of this requested permit, I do hereby agree that I 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 YOPNTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN A,7fORNEY BEFORE RECORDING YOU"OTICE OF COMMENCEMENT."
` - of Ow el Lessee/Contractor as Agent for Owner nature of ontractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF �t�,( ,� COUNTY OF �A=,t
The for oing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of 201 )_by this J`i of }—oircP_ 20LLby
( c,L r� 'Fe(-r- :.S Cow/ rerc,' 3
Name of person making statement. Name of person r ing statement.
Personally Known 4,OR Produced Identification
Type of Identification
Produced d• Nota Public State of Florida
Kell Lee Hite
t L 1a My Commission GG 367402
'l�pd' ExpiresQ6/19/2023
(Signature of Notary Public- State of Florida )
Personally Known LL---'OR Produced Identification
Type of Identification
Produced J ,0* xs Notilry Public State of Florida
i Lee Hite
My Commission GG 387402
�'Ecri<xpitrs08l19/2023
(Signature of Notary Public- State of Florida )
Commission No. LAO Z_ (Seal) Commission No. 311110 (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED