HomeMy WebLinkAboutWilson - Lineal AC replacement permit applicationALL 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
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Commercial Residential V//
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
Address: C I- 1
Legal Description: K-I y4 rpnl j) k �i`
Property Tax ID #:
Site Plan Name:
Project Name:
Setbacks Front Back:
Total Sq. Ft of Construction:
Cost of Construction: $ _5LA5�
Right Side: Left Side:
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Sprinklers
!—J Shutters
11 Generator
S Ft. of First Floor: _
Utilities:0Sewer USeptic
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Address: 3 �D9
City: _t i 'e ) ce Stater
Zip Code q Fax:7 72 3qO J
Phone No.
E-Mail: r
Fill in fe0imple Title Holder on next page ( if different
from the Owner listed above)
Lot No _&�
Block No.
QWindows/Doors
0 Roof
Building Height:
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Zip Code
Phone No.
E-Mail:
State or Cc
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my License:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
Roof pitch
Fax-.-- 3 --e ` 7—q
IU"IUNER/ENGINEER: — Not Applicable
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: Not Applicable
Name: —
Address:
City:
Zip' Phone:
MORTGAGE COMPANY: Not Applicable
Name: —
Address:
City: State:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
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.
Which is in con icmtawith anrepresentation
applicable' Home Owners Association rules,bylaws or and covenants that build
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
commencin ork or-r-Ocording your Notice of Commencement, e,
as Agent for Owner
ST bl` FLOI,e ,,,
C NTY OFRID [ 4. � e
The for oing instrument was acknowledge efore me
this J day of 20 by
� � , v5• h'z Gam► r
Name of p rson ,king statement
Personally Known OR Produced Identification
Type of Identification
Produced
Contractor/license
DATE OF FLORIDA
COUNTY OF S� LU U e
The forgoing instrument was acknowledged before me
this _a day of _4 20 i C4 by
�Je-irevV � rpcamn
Name of p rson making statement
Personally Known ✓ OR Produced Identification
Type of Identification
; "" CRAIG A. GR i'JIIAAN
�j `', "; My COMMISSION FF99M2
(Signature of Notary Public- State r Q
gnatu a of Notary Public- State
Commission No. (Seal) Commission No.
REVIEWS
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17
FRONT ZONING
COUNTER REVIEW
CRAIG A. ®RI
MY COMMISSION
(Seal)
SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
REVIEW _ REVIEW REVIEW REVIEW REVIEW
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