HomeMy WebLinkAboutMiller John & Joanne AC changeout 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 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
Address:
Legal Description:
sec -
Property Tax ID #: 62-5[) --6 2' -00 U . Lot No.
Site Plan Name:
_ Block No.
Project Name: 1 J ]1 ��-t'Fl
Setbacks Front Back: Right Side: Left Side:
ke - ke res -m Wal S �C'rYl
e- �3'�z 17 L5i_�_M 9 � h e&�er
Sprinklers
11 Shutters
11 Generator
Total Sq. Ft of Construction: S . Ft. of First Floor: _
Cost of Construction: $ )Z Utilities: U Sewer 0 Septic
Name i mn i,
Address: qtp d.
City: "e State
Zip Code: Fax.-7'7Z 9q -T?Z-7
Phone No. -
E-Mail: ar,).. rm/I it O'd ('erum'/n�-�;n e
Fill in fee'gimple Title Holder on next page ( if different
from the Owner listed above)
QWindows/Doors
Roof
Building Height:
Name: ."rj
Company: f
Address: !A `
City:
Zip Code: Fax:
Phone No. 7
E-Mail:
State or C unty License:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
State:
Roof pitch
M
W
Name:
Address:
City:
Zip: Phone
Not Applicable MORTGAGE COMPANY: — Not Applicable
Name:
State:
FEE SIMPLE TITLE HOLDER: — Not Applicable
Name:
Address:
City:
Zip: Phone:
Address:
City: State:
Zip: Phone:
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
Not Applicable
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
c,ommencingtwork oracording your Notice Of Commencement. _
r as Agent for Owner
Contractor/License Holder
t� v
C#F FLORIDA��R j _C STATE OF FLORIDA
NTYOF(til COUNTYOF__��j
The fo going instrjLpent was acknowledged before me
this _l_ day of c 20161- by
Name of pers�rfaking statement
Personally Known V OR Produced Identification
Type of Identification
Produced
(Signature of Notary Public- State
Commission No.
CRAIG A.
The forgoing instruMent was acknowledge efore me
thisdayofC' , 20 by
Name of perso 'making statement
Personally Known OR Produced Identification
Type of Identification
Produced
MY COMMISSION FF990902
1 �.
f gnatu a of Notary Public- State
(Seal) Commission No.
CRAIG A. GRI
MY COMMISSION
(Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER _REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE -- — - - - — --
RECEIVED
DATE - — — — — — —
COMPLETED
Rev.8/2/17