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HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: y a -� Permit Number: 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 PERMIT TYPE: PROPOSED IMPROVEMENT LOCATION: Address: %SC J< Re , Z—ye `{ Property Tax ID #: v ya ADD ©iy�-D�D -� Lot No. Site Plan Name: Block No. Project Name: DETAILED DESCRIPTION OF WORK: CONSTRUCTION INFORMATION: Additional work to be performed under this permit — check all that apply: Mechanical Gas Tank _ Gas Piping _ Shutters —Windows/Doors Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch Total Sq. Ft of Construction: Sq. Ft. of First Floor: Cost of Construction: $ �`% Utilities: —Sewer _Septic Building Height: OWNER/LESSEE: CONTRACTOR: Name &h'uy ' .X1, Name: Curtis Sammons Address: 7gOR Me CILtLlk izi a, Company: Custom Air Systems, Inc. C City: c n t SZ! .Li�c c State: Zip Code: _,2i q S Fax: Phone No.772 �'73 Y17 Address: 1615 SE Village Green Drive City: Port Saint Lucie State: FL Zip Code: 34952 Fax: 772-335-1968 Phone No 772-335-3232 E-Mail: Fill in fee simple Title Holder on next page ( if different from the Owner listed above) E-Mail custairsys@aol.com State or County License CAC051810 If value of construction is 52500 or more, a KtLUKUtU Notice oT lommencemeni a Icyun CU. If value of HVAC is $7,500 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 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 JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WffH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Signature of Owner/ Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder STATE OF FLORIDA & (I ppU4L STATE OF FLORIDA �, COUNTY OF Ul kteu' COUNTY OF VC _L The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me this aZ day of S.y4 -� , 20 /9 by this R1, day of S.ep � , 20 P? by 1%'Tl S Sit MXGn.S euRTIS 5Mh2DfiS Name of person making statement. Name of person making statement. Personally Known_ OR Produced Identification Personally Known %' OR Produced Identification Type of Identification Type of Identification Produced Produced (Signature of Notary Public- State of fforicla) (Signature of Notary Public- State of Florri l� CHRISTINE B EN ,+r� CHRISTINE B Commission No. � 61 525�6 * * AIYCOMMISSION# r ,.,.,4in MY COMMISSION # I mission No. C'c ra a� EXPIRES: Apn14, 21 ''F� �o� SM" 71.0 Budget REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev. 217119