HomeMy WebLinkAboutBuilding Permit Application Feb 27 2018 12:56PM Preferred A/C & Mechanicl 7728787510 page 1
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: a, Permit Number:
, RECEIVED
Building Permit Applicatio FFR �, 7 J13
Planning and Deve/opmentServices
Building pnd Code Regulation Division ST. Lucie County, Permitting
2300 Virginia Avenue,fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of lineV �C
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Address: LID k(. K (ori F4 NIt-gy '
Legal Description: vl 8"o S�0
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Property Tax 1D#: 3.;1a, 501- X1)05 -6g0 :;s Lot No. c;!
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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A( frS1RIPTi01V OF WORK:
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�`it7i�na war o e e Orme un er is permit-check a appy:
L�IHVAC Gas Tank Gas Piping _Shutters
❑ p g ❑Windows/Doors
❑Electric 0 Plumbing []Sprinklers ❑Generator ❑Roof Roof pitch
Total Sq. Ft of Construction: SFt.of First Floor:
Cost of Construction:$ i��L C:C _ Utilities: Sewer Septic Building Height:
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Name � Name: i �'gin JJ
-Address:4 OY('V kc-1 Company:
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City: State:_ Address: ' -L oi ,
Zip Code: C S Fax: City: i n State: �L_
Phone No. Zip Code: Fax:. A19.
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E-Mail: Phone No.dpi-064-1 C-9-:11
Fill in fee simple Title Holder on next page(if different E-Mail- 11cUe.Co'abp4�-cly(iaciy_)['rh.cc
from the Owner listed above) State or County License:4' 111 h eI95
If value of construction is$2500 or more,a RECORDED Notice of Commencement Is required.
Feb 27 2018 12:56PM Preferred A/C & Mechanicl 7728787510 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 thepermit 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 Horne 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
cornmencing work or recording our Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature ofContractor/License Holder
STATE OF FLO IDA STATE OF FLORID
COUNTY OF k il-Olf COUNTY OF (^'-f lL?If�
The forgoing instrument ras acknowledgbefore me The forgoing instrumen was acknowledged before me
this�day of� ,t� Z 20 by this day of - ,� 20_- by
/(I
f(f/ f 1t 1 �D C l pn br (.1 o CJ R) l C` )
Name of perso making4tatement Name of person ma ' g statement
Personally Known OR Produced Identification Personally Known it OR Produced Identification
Type of Identification Type of Identification
Produced Produced
ignature of Notary Public-State of Flo i a) (Signature of Notary Public-State of Flo"d
)
�j Nilci*LRarrm iyNicole L.Rom ri
Commission No.C- 64)111I5i '/ NOTARY PUB (commission Nor—.40 / NOTARY PUB
STATE OF FL IDA 5` STATE OF Fj
ComrrYJ GG04,529 -r
REVIEWS FRONT ZONING SUPERVISOR �
OR PLANS VEGETATION SEA TURTLE MWAM
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17