HomeMy WebLinkAboutBlocking Diagrams ALL APPLICAB_ EE�I, FQ . UST BE COMPLETED FOR APPLICATION TO BE ACCEPTED C�l
Date: O17 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 Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
.PROPOSED IMPROVEMENT LOCATION:
Address: JYJ D® 14110 >
Legal Description 'ikQ/J
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Property Tax ID#: Lot No.
Site Plan Name: Block No.
Project Name. .Li'i-��
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK: I
1p 00
Ott
CONSTRUCTION INFORMATION:
itiona wor c to e e orme under this permit—check a appy:
O.HVAC Gas Tank []Gas Piping Shutters Q Windows/Doors
NX
Electric 0 Plumbing Sprinklers E Generator Roof Roof pitch
Total Sq. Ft of Construction: Ga S . Ft. of First Floor:
Cost of Construction:$ of &00° 00 Utilities:uSewer Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name .ui! Name:
Address: D }. 5 Company:
City: State: Address: e
Zip Code: S y y'J A Fax: City: '!�Y State::1-•
Phone No. 946- 6 ,64- 932-7 Zip Code: 9#'911%5 Fax:
E-Mail: Phone No. 41&1- R!2-1-7
Fill in fee simple Title Holder on next page(if different E-Mail: lbj&U-0 40 4-6/k - Q � �_ .czt-&I
from the Owner listed above) State or County License: � 49
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If value of construction Is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Mq Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: N 14 Name: N hag
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 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. u intend to obtain financing, consult with lender or n attorney before
commencing,work or re rdin your Notice of Commencement.
s
Signatu fcaner Lesse ntractor as Agent for Owner Signa e of'C-OntractqVicense Holder
STATE OF FLORIDA f STATE OF FLORIDA 444464.,
COUNTYOF t9 n cC� '�v COUNTYOF
The for ioIng inst nt was ack owledged before me The for oing instru t was acknowledged before me
this ?s' day of 20 /�by this day of 20 by
iC P ILId,?-
(Name of person ackno ging) (Name of person acknowled. ' }
J
(Signature of Notary Public-State o Florida) (Signature of Notary Pu ic-State of Florida)
Personally Known 0 Produced Identification Personally Know 0A%ft�e119A*Jot ption
Type of Identificati c , DRAYMONDPRUE Type of Identifi ub1�t]'ARYPUeu .
MY LIQ STATE OF FLORIDA
Commission No. ESTATE OF FI9A Commission No.. C FF79267f55eal)
m#FF192675 Expires 1/26/2019
EXPIres 1/2
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS