HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED! _
Date: Permit Number: O ®�
I
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 I Resid'entiall X
I
PERMIT APPLICATION FOR: Mechanical i
"s—
�FOPQSE04) i?RQUEV) UT . 1 £_
Address: 7626 Green Brier Circle
Legal Description: POD 19 PUD II GREENBRIER (PB 41-5) LOT 61 (OR 3863=177)
Property Tax ID#: 3322-700-0066-000-7 Lot No.
Site Plan Name: ! Block No.
Project Name POLLOC i
Setbacks Front Back: Right Side: Left Side:
' I
0,"
ET TILED Ei RI!?T)ON=f F 1tO# Ks '4
M
Replace 4 ton AC system like for like
i I
•aK �'_�., .��. -,�, ,A¢< a,.,,�dx.arN s _x. xa.i av�,t`'£`„ ,��,bw'c� � ,rte,l. .a A *� a�
Additional work to be nertormed unrier this permit—check„all appy: j i
HVAC Gas Tank Gas Piping Shutters Windows/Doors
I I
0 Electric 13 Plumbing Sprinklers FIGenerator Roofl Roof pitch
Total Sq. Ft of Construction: S4200.00 . Ft.of First Floor:
Cost of Construction:$ Utilities: � Sewer Septic 'Building Height:
� roR
; C�NTRAc _ g
Name Sa e e en Name:
Address:
Isabelle en Company: ``
SAINT LUCIE PO
City.. PORT State:_ Address: BOX111 8
Zip Code: Fax: City: PAL State:
Phone No.
7727133221 Zip Code: 34991 Fax:
E-Mail: Phone No. 77277752 7
Fill in feesimple Title Holder on next page(if different E-Mail: AI t I.
from the Owner listed above) State or County License: 1 1 229
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
!
I '
i
I
i
I i
SUPPLEMEtITAL C�(JNSTRUCT.tON L13ENLAIN INFORMATION
.._a. .
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name: i A
Address: Address:
City: State: City: i State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: !Not Applicable
Name: Name:
Address: Address:
City: City: I
Zip: Phone: Zip: Phone: i
! i
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.
I
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. I
!
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 noon-residential use
WARNING TO OWNER:Your failure to Record a Notice of Commencement may result in yourl 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 recorOtEyour Notice of Commencement.
• I
i
Signa re o Owner/ see/Contractor as Agent.for Owner Si a of Contr for/License Holder
STATE OF FLORIDA STATE OF FLQ�,I��IN
COUNTY OF C�r,�C"�sz > COUNTY OF'VI�`
I
_ The fo oing instr ent was acknowledged before me The rgoing instrulr��nt was acknowledged before me
this , day of 206 by this / day of JANi 20� by
Ac';
Name of person making statementName of person making statement
Personally Known OR Produced Identification Personally Known X OR'Produced Identification
Type of Identification Type of Identification! j.
Prod ed Produced
!
kA Q
I !
(Signat re of Notary Public-Stat ) _. :�c('Signature of No b'c-S a e o Florida
,
LASHIN
I ! L
G� missi No. w�ryPubllc8t Ilodda
Commission No. yrs" aal;) Notary Public-Siate oi'Fjmisorldy sa Ackell
'ridr���e My Comm.Expires[ec �� ` .My Commisslon FF 234802
20,2018 �tp�wd� Expires 05/26/2019
Commission#F 17 9a
u oug^n Nano a1 NotaryAlsA
REVIEWS FRONT ZONING SUPERVISOR P VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW, REVIEW REVIEW REVIEW
DATE
RECEIVED !
R
ATE
OMPLETED
Rev.8/2/17
I I
i
i