HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 06/18/2018 Permit Number:
s -I J._
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 x
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
185 NE Canrona ave
waaE es5:
Legal Description: River Park- unit 4, blk 40, lot(map 34/21 s)
Property Tax ID #:
Site Plan Name:
Project Name:
Setbacks Front Back:
Right Side: Left Side:
Installation of a 4 ton 17 SEER AIC system with 10 kw heat
Lot No._
Block No.
CONSTRUCTION INFORMATION:
Additional worK to e e orme under this permit— check a apply:
lidHVAC M Gas Tank []Gas Piping _ Shutters Windows/Doors
Electric D Plumbing OSprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: 2500 S Ft. of First Floor:
Cast of Construction: $ Utilities: _ Sewer 0 Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name amen Pough
Name: Mark I ll
Address: 185 a Caprona ave
Company: est Choice ATC Inc.
Po saintucie
City: State:
w non .
Address:
City: Port saint lucie State: 1-1
_
Zip Code: 34983 Fax:
Phone No. 954-815-0386
Zip Code: 34953 Fax:
5757
Phone No. -
E -Mail: jepougou oa .com
Fill in fee simple Title Holder on next page (if different
E -Mail: bests oiceac,ps gmal .Com
State or County License: UA(A 815606
from the Owner listed alcove)
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: Not Applicable
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 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
commencinL7 work or recordine vour Notice of Commencement.
Rev. 8/2/17
signatur Q er/ Less
actor as Agent for Owner
si ur of Co or 'cense holder
STATE OF FLOR
STATE FLORIDA
COUNTY OF j,k kx
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COUNTY OF ,amt,
The forgoing instrument was acknowledged before me
The forming instrument was acknowledged before me
this � day of
20 5 by
this is day of 20�f5 by
i)CX,1, Mh IAi
22pc I ii
Name of person making statement /
Name of person making statement
V
Personally Known OR Produced
Identification V
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced -VL iDL— ki
Produced""___CL_-.".. IC L
(signature of No ubtic- Stat a ELL`� MULL
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Commission No. _
e Ij Commission# FF 1f��
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cion No. ea
My comm. wores Sept.
1 , orrtmission# FP 161,
My comm. expires Sept. 1
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17