HomeMy WebLinkAboutBlocking Diagrams All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 1 / )C�
Date: �• / Permit Number: !7 o7 " 1 ! 3.
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Building Permit Application
APR 10 2017
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: '
PR® `OSEI IN A ROUEMENT L®CAT10,N:
Address: Ov-, yr-
Legal Description: CiLiz, Re , q b4�, :5 Latt 3 ('OK 1,016 - L:2Q 1P
Property Tax ID#: � � �- 700 - OL0 "'®rev _ l Lot No.-3
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DET SLED Df�SCRIPTIO k .0'F Vt/ORl<•
/1 zr a-C� Z 0►✓ 1'n l0 J�P 5 i,a Ck IX01
CONSTRU ETII INFOR ATI"ON:
Additional work to be pertormed under this permit-check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator ��-q A2 Pitch
Total Sq. Ft of Construction: 1, q$b Sq. Ft.of First Floor: l r '2 5
Cost of Construction:$ 000 Utilities: —Sewer —Septic Building Height:
WIN NOEM LE5 E: CONTRACTOR:
Name (.7 - �n"� �6ri� e Name: AOCI Pum
Address: 1 �tohc����o�� r."►r� Co
!� mpany':-` I>►71�,
City: 1 ��-e i�7' i _State: Address'
r
zip`Code':� Q� Fax: City: �% P1'eY� Stater
Zi Code: ,3 V-1 L(7 Fax:
Phone No. 7�,2- 9 Z 1 - ,�9, p
E-Mail: Phone No ` 22=-JI2( :^29,5_0
Fill in fee simple Title Holder on next page (if different E-Mail
from the Owner listed above) State or County License__(v l°C' l32 7-2 ��
if value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SU�PPI.EMENTAL C«ONSTR+UCTION LIEN LAW INFORMATION:
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:
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 recording our Notice of Commencement.
J1NJ_iA&_ZS1 `§;off, 51��.
Signa ure of Owner/Lessee/Contractor as Agent for Owner Signa ure of Contractor/License Holder
STATE OF FLORIDA/ STATE OF FLORIDA
COUNTY OF IX,LI COUNTY OF W.
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this LJ�ay of 11,a i-r`r 204 by this lei"day of 120 (77 by
god Wa I tell,
(Nampe on acknowledging) (Name on acknowledging)
r
19na ure of Notary Pub is-State of Florida ) (Si ature of Notary Publ�ic-State of Porida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Id tification Type of Identification
ProducedProducedf
ao�";` � ,J,(�HNNIE HILLS,SR. iv au
Commission No. (��ChMMISSION#FF 211362 Commission No., .,.9�,�, ( ID�IEHILLS,SR.
�b * EXPIRES:July 18,2019 * * MY COMMISSION FF 211362
^t, X04 u 18 2019
UF IF- ro Bonded Th v Budget Notary Services.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.7/2014