HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED I "�
Date: Permit Number: t l '0aa0
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 X
PERMIT APPLICATION FOR: Mechanical
PROPOSED 'I',M!PROVEMENT LOCATION:
Address: 5703 BIRCH DRIVE
Legal Description INDIAN RIVER ESTATES
Property Tax ID#: 3402-609-0382-000-3 Lot No.
Site Plan Name: Block No.
Project Name: HAUGHIE
Setbacks Front Back: Right Side: Left Side:
i
DETAILED DESCRFPTION OF WORK::' l- '
3 TON
16 SEER
5 KW
CONSTRUCTION ,INFORMATION: i
Additional work toe nerformed under tispermit—c ec a appy:
HVAC 0 Gas Tank Gas Piping _Shutters nwi,nclows/Doors
11 Electric 0 Plumbing ❑Sprinklers Generator! Roof Roof pitch
Total Sq. Ft of Construction: /� �o Sq. Ft. of First Floor:
Cost of Construction:$ 4600.00 Utilities: Sewer Septic Building Height:
O x' NIER/LES IEE: CONTRACTOR=:
Name GINGER HAUGHIE Name: MARK A VINES
Address: 5703 BIRCH DRIVE . Company: AZTIL
City: FORT PIERCE State:_ Address: 2540 S1 MILITARY TRAIL
Zip Code: 34982 Fax: City: WEST PALM BEACH State:FL
Phone No. 772-332-8991 Zip Code: 33415 Fax:
E-Mail: Phone No. 561-433-2197
Fill in fee simple Title Holder on next page(if different E-Mail: PERMITS@AZTILAC.COM
from the Owner listed above) State or County License: CAC049253
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
I
i
I
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 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
j 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
commenS'rq work or recordW your Notice of Commencement.
i
_,001/
Sig ature df Owne /Lessee,•Contract'orsas Agent for Owner Signature ofnt�rac •r/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF PALMBEACH COUNTY OF PALM BEACH
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 5 day of SEPTEMBER ZQ_ by this 5 day of SEPTEMBER 20_ by
MARK A VINES MARK A VINES
Name of person making statement Name of person making statement
Personally Known x OR Produced Identification Personally Known x OR Produced Identification
Type of Identificatior Type of Identification
Produced ""°�"` jDJLN EDWARD GIFFORD Produced
i
MY COMMISSION#FF077427
1=DWARD GIFFOR
MY COMMISSION#FF077427
EXPIRES December 17,2017 ,�... :
A-0153 FloridallotaryService.com ..oF.FEXPIRES December 17,2017
;;op.••'
(S ature o Notary ublic-State of Florida) ( 'g ature of N Lary ' `i
Co ission No. FF077427 (Seal) Com ission No. FFo77427 (Seal)
i
i
i
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION' SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17