HomeMy WebLinkAboutBlocking Diagrams ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: 4 �
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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
Address:
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Legal Description: G/d�GGr/�f� �'/�r/11G—[J,✓!`� all,,—' e z o7
72'2- 19:Zq ZZ78- 9D7 )
Property Tax ID#: /-,7O/ 6,2 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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DETAILED DESCRIPTION OP WORK { Y
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Additional work toe nnertormed under this permit—check all that appy:
HVAC 0Gas Tank ❑Gas Piping _Shutters Windows/Doors
Electric 0 Plumbing Sprinklers E Generator Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ /-)00'ay Utilities: Sewer Ll Septic Building Height:
�?UIINER/LESSEE ' "' M =44" 4 �CONTRGTOR ry a �j �4 r
Name 414' lG S� O/�!'Ci�/�l/G Name:
Address: 7 5'o S',Qi9,dy/�.r✓ 57-- Company: /�/LGGs� L6rui� G-G� s.✓�
City: & G/LGL,
i State: EE Address:
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Zip Code: `T'987' Fax: City: state: L
Phone No. 7 7 2' ��ZS�-/3 79 Zip Code: 36i y Y 5P I Fax:
E-Mail: Phone No. 770--737z- 8'
Fill in fee simple Title Holder on next page(if different E-Mail: ,, 'I
from the Owner listed above) State or County License: 4zJ0ozS-;'//
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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SUPPLENIENTALMNSTRtJ�TION LIE D LAW II�FORMATION� tt
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: .I
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'lanother 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.
/ 5�_ s
9gnatur'e of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/Lice'nse Holder
STATE OF FLORIDA STATE OF FLORIDA ,
COUNTY OF -S+. I..uc1 e COUNTY OF
The forgoing instru�}ent was acknowledged before me The forgoing instrument was acknowledged before me
this 5 day of �.J U L ti 20 1 I—b, this 5 day of 20 17 by
C'kayA b V CC rtes Low
(Name of person acknowledging) (Name of person acknowledging)
i"/�`A �,�
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known X OR Produced Identification Personally Known �011 Produced Identification
Type of Identification Pr u e Type of IdentificationZJ1,40
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t1' 7Not3ry.Publlc State of Florida
��'ccc� Notary t��p State of Florida velirlda/�Commission No D Evelir 1�16resCommission No.�F yCOMA I F089786
fres 02/0412018
My Commission FF 089788Exaires 0
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
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