HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 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: Mechanical
.0bPOSED,IIVIFROVEIVIEN,T LOCATION:`
Address: "I b50 8 Occon rb,- c
Legal Description: The,�P6(1Ce's's C )-C' ��C-�(liol�-on s q r`c
Property Tax ID#:11to&-bl0-Ol(DO_000-S Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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DETAwILED.DESCRI.PTION OrWORK
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C C rnoo- e OLTP G TDnS 1 Gccr.0
GC►NSTRUCTION;INFORMATION "y
�diit`�iona workto e e orme under this permit—check a appy:
LJHVAC E] Gas Tank []Gas Piping _Shutters Windows/Doors
Electric Plumbing Sprinklers 0 Generator Roof Roof pitch
Total Sq. Ft of Construction: SFt. of First Floor:
' �-
Cost of Construction: $ 01 Utilities:Sewer 0 Septic Building Height:
OWNER/LESSEE ae CONTRACTOR
Name dc" )eY1ah&_[fff C ocob 4 UC(GL Name: PAC'VL'o V l(�SOO
Address: 79Z1 SW )(2J3rC1 -T'6'' Company: c5G v-lGL AM6'iCa
City: W iGr 1 t State:fl Address: 916S b,)L,J lb&d a
Zip Code:35169 Fax: City:Tf COui eycfafe_ State:
Phone No.c20�"�1Z'Q �] Zip Code:` �/ Fax: 95+—R �i
E-Mail: Phone No.
Fill in fee simple Title Holder on next page (if different E-Mail: eyrn,1S i'!Il/ ��iCPQrrIGy�Ca-co�'�
from the Owner listed above) State or County License: CACOIf(4�pdq
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SU,P�PL`EMENTAL CONSTRUCTION LIEN'LAW INFORMATION ° }
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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 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 in ion. If you intend to obtain financing, consult with d r or an attorney before
commencingwork ecordin our Notice of Commencement.
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_Signature of 0 e Cgnntr`actoras Agent for-Owner [Signature of CR-me r/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF .12 2D COUNTY OF AP�o�
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of,,-)G/)u a!LLI 20 1_by thisal day of3u 'K1j 20 j-J_by
P-s CIA r l C1 Lo 4 v n SO
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-State of Florida) (Signature of Notary Pub)ic-State of Florida)
Personally Known _OR Produced Identification Personally Known _OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. �pRt c�E/ (S&fry Ann Baychu Commission No. ati°�E/i �Sq�I�nn Baychu
z NotaryPublic-State of Florid s NotaryPublic-StateofFlorida
N c Commission#GG 33869
srFOF�Qe Expires 912712020 i,FoFr�� Expires 9;27/2020
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS