HomeMy WebLinkAboutBUILDING PERMIT ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 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 xxx
PERMIT APPLICATION FOR: Mechanical
PROPOSED IMPROVEMENT LOCATION:
Address: 105 N 40th Street Fort Pierce 34947
Legal Description: WILBUWE BLK 4 N 30FT LOT 6 ANDALL LOT7 (0.26 AQOR 710-592)
Property Tax ID#: 2408-603-0042-000-5 Lot No.
Site Plan Name: Block No.
Project Name: Ellis Residence
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Like for Like A/C Heat Pump replacement: 3 ton, 1 Okw, Vertical/Ground
CONSTRUCTION INFORMATION:
itsona workto e e orme under this permit—check a apply:
HVAC Gas Tank Gas Piping 11_Shutters Windows/Doors
®Electric Plumbing Sprinklers E Generator 1:1 Roof Roof pitch
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $ 6185.00 Utilities: Sewer El Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Ruby Ellis Name: Don Miranda
Address:105 N 40th Street Company: Miranda Plumbing &Air Conditioning
City: Fort Pierce State:_ Address: 750 NW Enterprise Drive
Zip Code: 34947 Fax: City: Port St Lucie State:FL
Phone No.772-370-2920 Zip Code: 34986 Fax: 772-621-2885
E-Mail: Phone No. 772-878-5123
Fill in fee simple Title Holder on next page( if different E-Mail: LDIODATO@MIRANDACOMPANIES.COM
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
T !rrr r-a
PIN wa .,`. v
d -S:
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:750 NW ENTERPRISE DRIVE 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
commepx,ing work or recording our Notice of Commencement.
Sighature.6f Owner/Lessee/Contractor as Agent for Owner Slgnatu e of contractor/License Holder
STATE OF FLORIDA y �-- STATE OF FLORIDA �.—
COUNTY OF �? L L'`!1 COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this.Q- day of ems-• �q 201�3s by this day of�_J �P_l L4 .20LJ_a by
—00
Name of person making statement Name of per on making statement
Personally Known ,,Z OR Produced identification Personally Known OR Produced Identification
Type of Identification Type of identification
Produced Produced
(Signature of Notary Public-State of Florida J (Signature of Notary Public-State of Florida)
Commission No =_ ._..__....Seal) Commission No. Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.B/ Lod 410dato Lod Diodato
Commission#GG069M Cammissiun#GG013;�258
Expires: Feb. 0, 2021 x Expires Fed►. 8, 202E
$1i11i11�5BMW -
���141fF15N♦ti