HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ILPermit Number:
• RECEIVED
Building Permit Application JAN 16 2018
Planning and Development Services
Building and Code Regulation Division
ST. Lucie County, Permitting
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential X
PERMIT APPLICATION FOR: Mechanical
PROPOSED IMPROVEMENT LOCATION:
Address: 106 N 38TH STREET, FT. PIERECE, 34947
Legal Description. WILBUWE MLK 1 S 55 FT OF LOT 3 AND N 25FT OF LOT 4
Property Tax ID#: 2408-603-0003-000-0 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
2 TON D�fT
14 SEER ��—� �lL G
7KW
CONSTRUCTION INFORMATION:
Additional work to be Dertormed under this permit—check all appy:
HVAC Gas Tank []Gas Piping _Shutters ❑Windows/Doors
Electric ❑ Plumbing ❑Sprinklers E]Generator E] Roof Roof pitch
Total Sq. Ft of Construction: 1,024 SFt. of First Floor:
Cost of Construction:$ 3875.00 Utilities:]Sewer OSeptic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name JOSEPHAT DECEMBER Name: MARK A VINES
Address: 1102 CLUB DRIVE Company: AZTIL
City: FORT PIERCE State:_ Address: 2540S MILITARY TRAIL
Zip Code: 34947 Fax: City: WEST PALM BEACH State: FL
Phone No. 772-882-2807 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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _Not Applicable
Name:JOSEPHAT DECEMBER Name:MARK AVINES
Address: 106 N 38TH STREET,FT.PIERECE,34947 Address: 1102 CLUB DRIVE
City: FORT PIERCE State: City: WEST PALM BEACH State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address:2540 S MILITARY TRAIL 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 intend to obtain financing, consult with lender or an attorney before
commencing r recording our Notice of Commencement.
eefo
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF PALM BEACH COUNTY OF PALM BEACH
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 15 day of JANUARY 20_ by this 15 day of JANUARY ,20_ by
MARK A VINES MARK A VINES
Name of person making statement Name of person making statement
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Si ture o at"6 Rd *0 13ifford ure o ary u Mt' tem I r Gifford
of Flonda
My Commission GG 147815 John Edwartl Gifford
�a» Expires 12/)�/ 21 Com sio No. My co mi;rrQG 147815
om , sio o. 1 f' !!fir
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17