HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: .3 f l Permit Number:
J.
aulliallng rerma Hppucavon
Panning 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
j PEKMI I APPLKC A I IUN FOR: To Select from dropbox, click arrow at the end of line
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PROPOSED IMI KOVEMEN I LOCAI ION:
Address: �SoD dl rLy 4XX, aL- "p-&
Legal Description,:
Property Tax ID 47�DD Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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DE:I AILED DESCKIP I ION UE WORK:
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CCONSTRUCTION INFORMATION:
- rti a wor to a er orme under this permit-check a apply:
ZHVAC Gas Tank []Gas Piping _Shutters F Windows/Doors
11 Electric Plumbing Sprinklers Generator DRoof Roof pitch
Totai Sq. Ft ofConstruction: Sq. Ft. of First Floor:
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Cost of Construction: $ 7 7Si Utilities:F1 Sewer 7_Septic Building Height:
OWNER/LESSEE; CONTRACTOR:
Name 4 0fin, .� Name: C U T( S �f4 a(p✓�c r1
i Address: RceL� fid ( Company: Cus-TorK A , r u S temS
City: e s E State: ►Jy Address: i 5 1�; l 1 dG-c a(r ee r� /
Zip Code: 13 850 Fax: i City. IPy R-r 9t- L uct,�_ State.
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Phone No. 60`l- 754 -N82 Zip Code: 3-+175:2.- Fax: `PL2- J 9
E-Mail: Phone No. 7'1 Z 3 3 S - 3)_3 2
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Fill in fee simple Title Holder on next page( if different E-Mail: C u S t c'I r Sys Cc o 1 C G
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from the Owner listed above) State or County License: D
if value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEM EN I AL GUNS i RUC i ION LIEN LAND I NFORIVIA I ION:
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: Ci-ty: State:
Zip: Phone: i Zip: Phone:
i -
FEE SIMPLE TiTLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name: I
Address: Address:
City City.:
Zip: Phone: up: Phone:
I certify that no work or installation ihas commenced prior to tihe issuance of a permit
St_Lucie County makes no representation thhat is granting a permit will authorize the permit holder to build the subject structure
f,which is in conflict with any applicable Home Owners Association rules,bylaws or and covenants that may restrict or prohibit such
structure-Please consult:•firth your Home O<.ners Association and re,iew your deed for any restrictions which may apply-
in consideration of the granting of this requested permit,I do hereby agree that I rill,in all respects,perform the work
in accordance with the approved plans,the Florida Building Cedes and St.Lucie County Amendments_
The fbHo- ping building pernhst applications are ewen.ptfrom undergoing a full concurrency review.room additions,
accessonr structures,stL4mming pool,fences,.rails,signs,screen rooms and accesseR,uses to another non-residential use
WARN ING 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, consultwith lender or an attorney before
commencing work or recording your Notice of Commencement.
Signature of OErner kessee;Contractor as Agent for O-vner ! Signature of Contrac orlLrcense Holder 1
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF _ _ , COUNTY OF
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The forgoing instru ner_t was acknowledged efore me The forgoing instrument was acknot:ledged before nhe
day of
this r / �'ttC<t1 20 �� this iaX day )Ir�: G, 20 I by
I
(Name of person ackrc::ledging (Name of person acknot:iedging)
(Signature of Notary Public-State of Rcrida j (Signature of Notary Public-State or`Icri..
. 1
Personally Known OR Produced Identification Personalty Kno.Am OR Produced Identification
Type of Identification Produced ` Type of Identification Produced
- ')0P 4o CF'Ri� :r iri=i
Commission No- a Cti CHRI.SMEBENi4}Ihmrssion No. .` 6'� ? --= 05MG
* * MY COMMISSION 3 G052546
m� c EXPIRESAprd�1(125
�art�o aarAeeTivu9udgerN!wySwv es r •� �—�"rtprrry 6Efi1GLi j-
*_ * MyGMA issiai#GG%7:46
Rev-ised 07/15i2014
E%P1REs:A94,2021
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REVIE\NS FRONT ZONING = SUPERVISOR 1 PLANS VEGETA,IOPI SEA TURTLE [VIANGROy:'E
COUNTER REVIEW REVIEW REVIEW REVIEW � REVIEW REV W' �
DATE
COMPLE T E —
INITIALS
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Work Order#106062 https://admin.servicefusion.com/jobs/printJob?dispatchJobld=V 1...
DATE 03/18/2019
Custom Air System Inc TIME 10:45 am- 11:45 am
_ ........
DURATION 1h
1615 SE Village Green Dr, Port St. Lucie, FL
34952, 772-335-3232 TECH(S) NATE
12198 County Rd 512, Fellsmere, FL 32948, JOB# 106062
772-571-1080
AfterHours7723590351 PO#
customaironline@gmail.com
PAYMENT Check, NET 30
CUSTOMER SERVICE LOCATION
BETTY SHEARS BETTY SHEARS
l 8580 MARYANN LANE 8580 MARYANN LANE
PORT ST LUCIE FL 34952 PORT ST LUCIE FL 34952
(607)754-0287
JOB DETAILS A/C NOT COOLING
COMPLETION
NOTES
t
Description Qty Rate Total
i
SUB-TOTAL: TIME&LABOR: EXPENSES: PMTS/DEPS: TOTAL DUE:
$0.00 $0.00 $0.00 $0.00 $0.00
_...... _ .... .___.___-"..... :- ........................... .................. ....._ ,. .... .. ............
CUSTOMER MESSAGE PRE-WORK SIGNATURE POST-WORK SIGNATURE
Thank you for your business
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