HomeMy WebLinkAboutBuilding Permit Application From: 11/15/2017 12:03 #095 P.0011003
ALL APPLICABLf INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:_ /711. 1''��77���
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Planning and Development Services Building Permit Application NOV 15 2017
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34981
Phone.(772)462-1553 Fax:(772)462-1578 Commercial Residential x
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
Ru.. Os�D IM ROS/ i1JI NT LOrrA 'IO'1U r:-: .
P CtP
Address: J� -J nes`�'�. --
Legal Description. P RT F
INO SHORES
(PB 43-6)LOT 46
0
Property Tax ID#: 1312-501-0119-000-6 Lot No.460
Site Plan Name: Block No.
Project Name:
Setbacks Front
/ �( Back) Q Right Side: Left Side:
AC CHANGE OUTAcid ,
COf�STR�CTIQI� INFORMAT�.ON � ,'
3
itional work toe performed un er t is permit—cheCK all apply:
HVAC Gas Tank Das Piping _Shutters ❑Windows/Doors
11 Electric El Plumbing ❑Sprinklers 12 Generator Roof Roof pitch
Total Sq.Ft of Construction: S Ft.of First Floor:
Cost of Construction:$4410.94 utilities:0Sewer aSeptic Building Height:
Name rz Name: 1L C DY'
Address: K� Company: UNIVERSAL AIR AND HEA
City: State:EL Address: a
Zip Code: 34951 Fax:FL City: Ca\f L - State:FL
Phone No.817-937-5236 Zip Code: 33314 Fax: 954-318-0584
E-Mail: Phone No. 954-581-7110
Fill in fee simple Title Holder on next page(if different E-Mail: PERMITTING@UAHAC.COM
from the Owner listed above) State or County License: CAC058142
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
it
From: 11/15/2017 12:04 #095 P.002/003
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
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 int tain financing,consult with lender or an attorney before
commencin work or recordi ce of Commencement.
f'
Signature of Owner/ ritractoras`Agentfor Ownei" :TATE
g e f ontractor/License Holder
STATE OF I D F FLORIDA
COUNTY OF-- COUNTY OF--
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this�day of Nov 20_ by this 6 day of OCT 20_ by
�XN MICHAELFORGIONE
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Name of person makings tement Name of pe sn making statement
Personally Known_Z41_OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
`�. Rrz Com.
(Signature of Notary Publi -St �pf.: lori s j ( Ignature of Notary Public-St e o• (, a r- "
,Fl y/.,7 '-� _ p'`.�(in< S AEiD Y'6flC�'t�F'�
Commission No. y 1 k MM@YiMISSION�rFF0883 .0 mmission No. ` ``'� 3 7 ;'�$�I�I�OMMISS!ON t/FF 356
EXPIRES February2,20 8 �`-'�O
'•-: ' EXPIRES February ?8
(43,1130A 0153 Florida NotaryServ!ce.com (407)393-0153 Floridallotaryservice. o
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17