HomeMy WebLinkAboutBuilding Permit Application Dec 15 2017 13:43 ,i 4 Air Conditioning 7724488145 page 2
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCWrED
Date: -C 't Permit Number:
Building Permit Application EC 15 20V
Planning and Development Services
Building and Code Regulation Division. L�i ie county,
23W Wrginta Avenue,Fort Pierce FL 34982 5t Lucie C, ou L
Phone:(772)462-iSS3 Fax:(772)462-1578 Commercial Resident! I
PERMIT APPUCATION FOR: To Select from dropbox, click arrow at the and of inIN e
l � GAPoe+ U Address: zeLet V.0
Legal Description: U�'�G�-t �� p -�`�� 127
G 13qg
Property Tax ID#: off' _ �- "7 — tQ - Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
i
MbStl
ACICUUOnal WoMto under MIS perm -checK all tm apply,
HVAC �~-!Gas Tank Des Piping _-,Shutters Wi dows/Doors .
Electric i._t Plumbing Sprinklers QGenerator 0 Ro Roof pitch
Total Sq.Ft of Construction:: S .Ft.of First Floor:
Cost of Construction:$ 7� Utilities:tSewer USeptic Build i g Height:
Name Q t-Vai,Te fftaei 4 Q U Q tt1CC-i` Name: + r
Address: 7 ZC r=Lf- Company: �►^ -
City:_ +Dr-i� S4-LAW f- _ State: rG Address: rZ
Zip Code (o Fax: City: e4_ State:
Phone No.C:1-72) -711' .258'a Zip Code: Fa :7'!Z GI�/.�•�'1�5~
E-Mail: Alfa Cite o? Cam 40X1.AAl -' Phone No. -7 7 Z q(0q_ Z rr
Fill in f simple Tide Holder on next page(If different E-Mail: 0kyl i Q aC Com
from the Owner listed above) State or County License: 191-73-31
ff value of construction Is$2500 or more,a RECORDED Notice of Commencement is required.
Dec 15 2017 13;43 i 4 Air Conditioning 7724488145 Page 3
Arm
"DESIMONENGiNEER: 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 nd Installation as Indicated.
I certify that no work or Installation has commenced prior to the Issuance of a permit.
5tt.�L,uude County makes no repreer�tation that Is granting a permit will authorize the rrnit holden to b lid the subject s�ucture
which is in W1 Ict with an pplicable Horne Owners Association rules,bylawsc�ran covenant that m ntstrict or proidbtt such
structure.Please consult wyit�i your Home owners Association and revlew your dead for any restrictions ich may apply.
Inconsideration of the granting of this requested permit,I do hereby agree that I will,In all respects,pe orm the work
In accordance with the approved plans,the Florida Building Codes and St.Lude County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review:room dditions,
accessory structures,swimming pools,fences,walls,signs,screen rooms and accessory uses to another on-residential use
WARNING TO OWNER:Your failure to Retard a Notice of Commeancement may result in r paving twice for
improvements to your property.A Notice of Commencement must be recorded and p ed on the jobsite
before the first inspectlon.If you intend to obtain financing,consult with lender or an a omey before
commencingwork or recordin ur Notice of Commencement.
� r
Signature of Ow Lessee ;rtmctor as nt for Owner Signature of con r/Ucense H61d r
STATE OFF �g
COUNTY OF 34- COUNTY OF 7s weet`-el
The forgoing Instr Hent was a nowledged before me The fo in ent was cknow edged before me
this„ day of W j .2ka by this day of 2Q�by
Name of person making statement Name of person making sta ment
Personally Known_V _OR Produced identification Personally Known_� OR ProducedIdentifleation
Type of identification Type of Identification
Produced Produced
{Sign Notary Pubk-State of Florida (signal Notary Public-State o iorlda)
Commission No. FIg "I ;".w�a I HaLYNfME r•• "OLLYlilM
AIM
.�; 73Z * IIYOOi/�8810H/Ff mmisslon No. ,�MCM
�+ SknsudpolV�aMry�1 �5r
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEAT RTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVI REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17
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