HomeMy WebLinkAboutCCF03152016_00000,PP ,LICABLE INFO MUST BE COMPLETED FOR APPLICATION'TO BE ACCEPTED
Date:
J —�� Permit Number:
� -
I
Planning and Development Services
Building and code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Address
Legal Description:
9�5-
Building Permit Application
Commercial _ Residential
Lot No.
Property Tax ID #: � ya�f �C — �
Block No.
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
Name Rn/C F A/ J�
CUM*CUM*s�c
Address: 7q, 911 a"Z.�Q"
City: iG'/L` .S� � ,c, State: r
Zip Code: %�!Z Fax:
Phone No.
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: urt(5 fo MY)On S
Company:
C,us r�ng R r
ALJ s fe was
lAJ c
Address:
ll� l5 S �i I
D�
Additional wor to a pe Orme under this
permit — c ec a tat
appy:
Mechanical _Gas
Tank
_Gas Piping
Shutters Windows/Doors
_ —
_ Electric _
Plumbing
— Sprinklers
_ Generator — Roof
Total Sq. Ft of Construction:
c )
Sq. Ft.
of First Floor:
Cost of Construction: $
_j-�3
Utilities:
—Sewer _Septic Building Height:
Name Rn/C F A/ J�
CUM*CUM*s�c
Address: 7q, 911 a"Z.�Q"
City: iG'/L` .S� � ,c, State: r
Zip Code: %�!Z Fax:
Phone No.
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: urt(5 fo MY)On S
Company:
C,us r�ng R r
ALJ s fe was
lAJ c
Address:
ll� l5 S �i I
D�
City: PC,Q-T ST Luc
State:
Zip Code:
34 �2,
Fax: 'l7a US- ) X26
Phone No.
77,2 3IL_
L L
E -Mail:
C ficoJr-
c )
S a e
State or County License:
CAC 05 ) a
/O
If value of construction is 2S6>Yor more, a RECORDED Notice of Commencement is required.
- Not Applicable
Name:
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address
City: _
Zip:
Phone:
MORTGAGE COMPANY: — Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name: _
Address:
City:_
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.
In consideration 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 jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recorcUVg your Notice of Commencement /2
/ Agent/ essee
Signature of OwnerI Signature of Contractor License Holder
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
this S day of���� , 20r_ by
G(/n1l.r&', inC)L�"
(Name of person acknowledging)
"�q
(Signature of Notary hblicc-- State of Florida )
Personally Known ✓ OR Produced Identification
Type of Identification Produced
RY
7
Commission No.
REVIEWS
RECEIVED
DATE
COMPLETED
FRONT ZONING
COUNTER REVIEW
CHRISTINE B. ENC
MY COMMISSION 4 EE
EXPIRES: April 41
SUPERVISOR
REVIEW
STATE OF FLORIDA
COUNTY OF �-
The forgoing instru�entwascknowledged,before me
this day of G*i'� = 20/t/ by
(Name of person acknowledging)
(Signature of Notary Public- State of Florida )
Personally Known OR Produced Identification
Type of Identification ProdduceJd
��J �ac7+°�p0.'PUB ea
NEB B. ENGLISH
,Commission No. # * MOMMISSIONtEE859284
I" IRES: April4, 2017
s r
�c Fl 0twy Ser Io-
es
PLANS VEGETATION SEATURTLE MANGROVE
REVIEW REVIEW REVIEW REVIEW