HomeMy WebLinkAboutBuilding Permit Application-PPLICABLE INFO MUST BE COMPLETED FOR APPLICATIONTO BE ACCEPTED
Date: 1
Planning and Development Services
Building end Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Address: ICG
Legal Description:
Permit Number:
Building Permit Application
Re
Commercial i ential
s d
Property Tax ID #:t�
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
Mechanical
Electric
_ Gas Tank
_ Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ --r3 ! '�)
_ Gas Piping
_ Sprinklers
Lot No.
Block No.
_ Shutters ! Windows/Doors
_ Generator _ _ Roof
Sq. Ft. of First Floor:
Utilities: _Sewer _ Septic Building Height:
Name � C�-c V ,� j, 7- \ vNr1 Cc,
Address: --D47 t—,C (1 ck-�-c Cn 2Cl
City: %-a , �\ e- State: f (�
Zip Code: 1(r t ? Fax:
Phone No. .-7 ZZ_- S' `I - (�`"j r13
E -Mail:
Fill in fee simple Title Holder on next page ( If different
from the Owner listed above)
Name: Cutts Sa-mmorl
Company: Cus-r&,m Lr S#stems Nc,
Address: t( IS S E Ti I(aa -p- Q rwrt Dr -
ciity: Por[ ST Ike, State: R.
Zip Code: 34 9S2 Fax: `77; 33,S -
Phone
35Phone No. 77.. 33S _3232
E -Mail: CuSt41r cu c V C�o ) .6c-^
State or County License: CA C 0519 /O Se
If value of construction is26Kor more, a RECORDED Notice of Commencement Is required.
SUPPLI=MEN IAL CONS I RUC I ION LIEN LAW INFOKMA I ION:
DESIGNER/ENGINEER: _ Not Applicable
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:
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 exemptfrom 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 recording your Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF St 4 U(T i E COUNTY OF_ f Ly c
Thefor oing instrument was acknowledged before me j The forgoing instrument was acknowledged before me
this a day of _ (�G� 20 11 by 1 this aJ day of �i.�� 20 l Z by
- Curbs 6PrmoylS mil 5 SLnMmo(A 5
(Name of person acknowledging ) (Name of person acknowledging)
GQ L.� 1C �� /•
IL
(Signature of Notary Public- State of Fl a )
Personally Known _✓_ OR Produced Identification _
Type of Identification Produced_ _
Commission No. 6 05� q6
Revised 07/15/2014
REVIEWS I FRONT ZONING
COUNTER REVIEW
COMPLETE
INITIALS
(Signature of Notary Public- Stat . of Flori
(S�gn Y
Personally Known OR Produced Identification _
Type of Identification Produced_
CHRISTINE B mission No
* MY COMMISSION t 0 052548
�...............EXPiRES AP!11..2021......._.............. ..... _............. _.
kmdM Thu MW No" f� Swim
* MY COMMISSION800052548
EXPIRES: Apr4 4, 2021
SUPERVISOR
I PLANS REVIEW VEGETATIONI S
REVIEW EATURTLE MANGROVE