HomeMy WebLinkAboutBlocking Diagrams All APPLICABLE INFO'MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �`'� �j
Date: �� Permit Numbek 1 ® G J�-f
•
Building.Permit Application
Planning and'Development Services C /
Building and Code Regulation Division Commercial Residential V
2300 Vfrginla Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax: (712)462-1578
PERMIT APPLICATION FOR:
PROPOSED-IMPROVEMENT LOCATION: ` 5.5 N ALS Rvr4l,
Address:
Property Tax I #: ���� "�A1 'Oda 'OQO-8� Lot No.
Site Plan Name: Block No.
Project Name:
I _ _
[DETAI LED:OESCR'IPTION OF WORK:
c, S'
I .
;New Electrical Meter Second Electrical Meter
i
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit-check all that apply:
tLMechanical _Gas Tank _Gas Piping _Shutters Windows/Doors _Pond
I
Electric Plumbing _Sprinklers Generator Roof Pitch
Total.Sq.Ft of Construction: cr Sq.Ft.of First-Floor:
Cost of Construction:$ HI` 'Pa Utilities: _Sewer _Septic Building Height:
OWN ER/:LESSEE: CONTRACTOR!
Name Y- Name:
Address: NS .Company: ll% C .
City: State:f�_ Addr s: S
Zip Code:� Qtr7' Fax: City: State:�L-
Phone No(��y:6i- 3ql -33tr Zip Code.141N,53 Fax:
E-Mail:Iv Phone No r
Fill in fee simple Title Holder on next page(if different E-Mail �S Q
from the Owner listed above) State or Co my License
If value of construction is 2500 or more,a•RECORDED Notice of Commencement is required.
If value of HAVC is$7,500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION 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 cori lct 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
I WARNING TO OWNER:Your failure to Record a Notice of Commencement may result in paying twice for
improvements to your property.A Notice of Commencement must be recorded in the public records of St.
Lucie County and posted on the jobsite before the first inspection. If you intend to obtain financing,consult
E with lender or an attorney before commencing work or recording our Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF COUNTY OF ORID �J !. COUNTY OF STATE OF ORIDAS
Sworn to(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of
Physical Presence or Online Notarization Physical Pies me or Online Notarization
this 3 day of 20M by this 1), day of C L.Vj2 202ISD by
f •
1 Name of pe son making statement. Name of per n making statement.
Personally Known OR Produced Identifications Personally Known OR Produced Identification
Type of Identification Type of Identification
Produ Produced
ce
- c -
(Signature of Notary Public-State of Florida) (Signs _.. y ruairc-state of Flori )
"P Commis
Commission No. v•• .c SHAH M-RAHMING � hti
MY COMMISSION#GG 275060 �i. s MY COMMIgS10N ��HMING
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Bonded Thru otary PiiiWR
;� bond ru of Decetuber 20,2022
REVIEWS F PLANS S 1JTdDRTA&,.e MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW
j DATE
RECEIVED
DATE
COMPLETED
ev.5/6/20