HomeMy WebLinkAboutBuilding Permit Application Mar 27 2018 15:14 i 4 Air Conditioning 7724488145 page 2
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: � PennitNumber:
Building Pp Permit Application REe�ivED
Planning and Development Services (t�,p. 7 'i5 18
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 L' Tenl:6
. t_ County, rmitting
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Re
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of liner} U
Address: r i P—r C.2 F1, Lf
Legal Description:
sPc oq
Property Tax ID#: a 30q - 3a a ^ 00 O 3" 000—q Lot No.
Site Pian Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
R ;
Additionalworktobenerformed under this permit—check a appy:
HVAC Gas Tank Us Piping _Shutters Q Windows/Doors
11 Electric 0 Plumbing Sprinklers Generator Roof Roof pitch
Total Sq.Ft of Construction:" S Ft.of Flrst Floor:
Cost of Construction:$ L41 � • 01) Utilities: Sewer Septic Building Height:
Name MO SSeCa. Li't'QAinc Name: S ►�
AddlI (o S 1CC11- Company: J e C
City: we State: fZ Address: 3) M0 ISI'�d -
ZE 2 p Code: ,�Gf 5 3 Fax: City: �► [� Stater
Phone No. -72 -7 C.,-3 3�l,�7 zip Code: 3 Lt-I Fax:-77 Z 442--gl 11
E-Mail: �J 2u�M SS Cca o?q,�yLa ( �i�n" Phone No. `7 7 2- (o Z 7 2--
Fill in fee simple Title Holder on next page(If different E-Mail: 10 kA O-C ✓�G�c 1 �'-�m
from the Owner listed above) State or unty License: L'4C 1 g 17 3 3
If value of construction is$2500 or more,a RECORDED Notice of Commencement Is required.
Mar 27 2018 15;14 i 4 Air Conditioning 7724488145 page 3
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 addition's,
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 flnancin& consult with lender or an attorney before
commencing work or recording our Notice of Commencement.
% V k �_ X V_
Signature of Ow Lessee ontractor as Ag nt for Owner Signature of Cont r/License H61der
STATE OF FLORIDAyj r STATE OF FLORID&—,
COUNTY OF , )7r- L.LL COUNTY OF 7:1__ Lti u
The forgoing instrument wa acknowledged before me The forgoing instrument was knowledged efore me
this day of 20� by this�day of 20�by
ncooi A psi', T�( V IrUla_J 4 -C�kzt_D' i 1v1.
Name of person making statement Name of person making statement
Personally Known OR Produced Identification Personally Known �e2 _OR Produced Identification
Type of Identificatiio�nC'�� Type of Identification
Produced Produced
(Signatki,lif Notary Public-State of Florida) (Signat f Notary Public-State of Florida)
HOLLY NICOLE KU KWLE KULNW
Commission No. Flq2�3Z * e,�1WMMIISS104#FF14 ommisslonNo. �����. _( �
EXPIRES;Augu815,261 EXPIRES,Auguat 5,2018
?osr� 8adedTtuuBudpe Nemtyb �OF BddtlTfruKdDdNUY&H*01
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17