HomeMy WebLinkAboutBuilding Permit Application Jan. 12 .2018 09:52 AM ACT Heating & Cooling 7728126250 PAGE. 1
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1 5 1 Permit Number:
•
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 v/
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line q C
PROPOSED IMPROVEMENT LOCATION:
Address: 'T 21�I 5t,JM d r e b, I Q r r a C c--
Legal Description: S T 1r Q n e qVA:(` fin 0�f�-- c#G sir,,
AU rt` V-Aanf<
Property Tax ID#: 33a� �O 5 4 d30- 800-$ Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
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CONSTRUCTION INFORMATION:
Additional work to be performed under this permit-check all appy:
HVAC Gas Tank
]Gas Piping _Shutters ❑Windows/Doors
11 Electric Plumbing Sprinklers []Generator 0 Roof Roof pitch
Total Sq. Ft of Construction: S . Ft. of First Floor:
Cost of Construction:$ ,�O � c0 Utilities: Sewer E]Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name atl Name: , "ncy-fhrin
Address: '7 11 g S W MOi rS� _Z UA CL Company: t4 0 7- +- ��
City:.�o }- S�- L"r, Stater Address: i4to-a Luc;Q � t�z312
Zip Code:?'4!12El Fax: City: tet` st- L-,±E t C. State:44
Phone No.f�& O� -5`J I Zip Code: 3 Fax:
E-Mai{: Phone No. -77�? 45/2 LoZ 15 0
Fill in fee simple Title Holder on next page(if different E-Mail: c o;
from the Owner listed above) State or County Licens : CPrG 19d n U2
if value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
Jan. 12 .2018 09:52 AM ACT Heating & Cooling 7728126250 PAGE. 2
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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 Co encement may result In aying twice for
improvements to your prop rty.A N I e of Commence en t ust be rec ded a post don a jobsite
befo the first inspection. you in n to obtain financ ng, co suit with nder an at mePefore
co encin work or rec din o r tice of Commen emen
Sig ure Owner/L ss /C tactor a Agent for Owner VgnUare of Contra cto/License Ho der
AT F FLORIDA OF FLORIDA
TY OF • TY OF Ll ecru
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this�i _day of Y_a11_ro-+�-� 20�� g by this&day of 20ffL by
�., oGf�lGe ys C)n a+11,-A n Ar,A-9 r C 1.
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
(Sign re of Notar Pu, (Sign re of Notary Pubic 5 FloridQIItNNIE KNIGHT
JENNIE KNIGHT .:
'v MY COMMISSION#GG13551
Commission No. oMMISs(f WW GG135511 Com fission No. -' Ek *August 17,2021
_ "•;
+2• EXPIRES August 17,2021
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17