HomeMy WebLinkAboutMECHANICAL/HVAC RESIDENTIAL- REPLACEMENT SYSTEM ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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Building Permit Application JUL - pfi�
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
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Address:
Address:
Legal Description:
Property Tax ID#: 3)"l `V Q ' (Ja 3,-:�� C%D V Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DET1L`EDSDESCRIPT(01�OF WORK
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CONS�RU�CTIO`N�INFORMATION3
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Additional work toe eFrormed uncler this permit check all appy:
HVAC Gas Tank E]Gas Piping _Shutters E]Windows/Doors
Electric O Plumbing OSprinklers O Generator Roof
Total Sq. Ft of Construction: 5 Ft. of First Floor:
Cost of Construction:$ .��> d`� Utilities:iSewer OSeptic Building Height:
OWtilER/LESSEE r _ CONTRACTOR
Name ��.GI� �� Name: C,-r
Address: "l-IFS-0 1-.-3 Company:,4/,2 C�P tr-,
City: /� �`��' State: Address: -
ZipCode%-3 V 925-2, Fax: City: Stater
Phone No,772. &.)PO ,_5~.! //' Zip Code:-,3 t} F,97 Fax:770, -'2-S -7 G127-6
E-Mail: Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
_ ( 1
SUOPL'(MENTAL CQNSTR;UCTI.Q.N LIEN LAW INFORMATIO"N.4
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 orinstallation 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.
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ignatu of Owner/Lessee/Agent Signature of Contractor/License Holder
STATE OF FLORID t STATE OF FLORIDA
COUNTY OF v7 COUNTY OF fgnarh'n
The forgoing instrum t was acknowledged before me The forgoing instrument was acknowledged before me
this day of 20/7 by this'd-Q day of Sone 20 \`l by
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(Name of person acknowledging) (Name of person acknowledging)
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�(SiCg_naturAof No ate of Florida) (Signature Notary Public-State of Florida)
Personally Known OR Produced Identification L Personally Known OR Produced Identification
Type of Identification Produced ` flVh� 17 Type of Identification Pro
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SS 11 ovs"` , KARRY BOTTERN
Commission No. ,""" LUZ(Re�ILUGOLECKI Commission No. �: .° Not�ri(R6lc-State o1 Florida
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Notary Public-State of Florida Commission#�FF 948940
a=_ .•- I-OPMd;••' My Comm
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Revised 07/15/0114 �^ Commission#FF 037123
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW_
DATE
COMPLETE
INITIALS